Miss Purple Stethoscope

I think I've got it all figured out!

2011-05-07T13:02:00.007+10:00

Okay, so a big claim to make... but at times, amongst the choas and confusion that comes with having to make a million and one choices about life, career, holidays, etc, there are moments (probably short-lived) when one feels like they've got it all figured out.

For starters - application for medical internship positions in NSW opened yesterday. It's been a horrendous task deciding how to preference the 15 or so networks on offer because really, at the end of the day, you could end up with preference 1 or preference 9 (for the past 3 years 100% of first round allocations were within the first 9 preferences). So you have to be realistic about deciding which places you'd be happy working in, even if they're not your first preferences. I chose to preference based on geography (hospitals close-ish to where I live), but also taking into considerations places that have accredited vocational (specialist) training programs that you're interested in. At the end of the day, I wouldn't be thrilled getting preferences 7, 8 or 9, but it wouldn't be the end of the world either. I haven't put in my official application yet as I need to get a letter from the university confirming my enrolment and potential graduation status, so hopefully will do that in the next couple of weeks. Beyond the anxiety and stress of this completely random allocation system, it's so exciting to be applying for a "real" job (and really, for me this is the first job that I have applied for since getting my job at the pharmacy 10 years ago!).

Next up - thinking seriously and realistically about specialities. Still a bit early, but it does help to have an idea as it could influence where you preference higher for internship hospitals (ie some hospitals have better a reputation than others when it comes to certain specialities). So I've been going backwards and forwards between emergency medicine and O&G; but since starting my anaesthetics rotation 2 weeks ago, I've disregarded both!! Anaesthetics is it, really I just know it! A few years ago, at the end of my first year of medical school, I went on a 2 week elective to Fiji where, while on a surgical rotation, saw anaesthetics in practice for the first time. It was then that I thought anaesthetics could be for me; but with little exposure since, I hadn't really considered it to any great deal. Having just finished gynae surg in the rotation prior to this, I'm now fair sure that at least the G part of O&G is definitely NOT for me. I was so disinterested and just plain bored by the end of the rotation; even though I applied myself as much as I could (I really did!!).. but it got me thinking and moving away from O&G in light of this. Also didn't help that I went to Phuket straight afterwards, which then got me thinking even more about how much I value my holidays and travelling, that I truely appreciated how offensive a career in O&G would be to one's leisure time :-S Anyway, this rotation couldn't have come at a better time. It's been priceless having consultants and registrars on board to talk to about the training program and what is involved in the way of time commitments during and after training. Also the rotation itself has been a good mix of the practical and theoretical. I got my first ET intubation this week! I tried 3 times without success but can now proudly say that I have done a few (4 in fact!) successful intubations. I've also gotten some invaluable practice in other skills (more essential for an intern) such as supporting an airway and ventilating in the correct way using jaw thrust, sealed mask and bag; as well as some much-needed practice in cannulating. Between cases, my supervisors have all gone out of their way to give me tutorials on the basics of anaesthetic theory which have helped demystify what is otherwise a potentially complex area of medicine. I wish this rotation was longer than just 4 weeks - I would love to go into greater detail with the theory and learn new skills.

This brings the third area which I've (sort of) finally organised - my elective term. It'll be my last elective as a medical student, I always thought I would go somewhere totally out of this world; picturing in my mind an imagine of my hands buried elbow-deep in someone's open thoracic cavity, heroically performing a cardiac massage (I have no idea where I even got this image from - I don't even want to become a surgeon let alone a CT surgeon!). Lots of people from my year are going to Africa, some even braving the likes of Bara in Jo'burg - but now that it's come to it, I've found myself not really that ready or compelled to take on such an adventure. So I thought long and hard (well, not that long and hard as you will see) and have decided to return to Fiji one more time, to where it all began, and complete an elective in anaesthetics - this time with a little bit more knowledge and wisdom than last. I'm very excited actually, it almost feels like a home-coming. I made a lot of friends and met some wonderful characters when I was there last, so it will be nice to see them all again. Another thing, this time I plan on travelling around and experiencing Fiji culture away from Suva. I've set my sights on booking a 7-night diving trip with Tui Tai expeditions, to venture out away from the tourist tracks that tend to be quite numerous around Fiji.

Anyway, much to look forward to! On a toned-down note - I have a mid-year exam in about 10 days that I have done absolutely no study for. So on that note I will leave you, and probably check back in again before I head off to Mudgee for my third John Flynn Placement.

Review: The Pavilions Phuket

2011-05-03T12:42:00.000+10:00

Several weeks before departing for our week-long vacation to Phuket, one of my well-travelled mentors at work gasped at horror that I would want to venture anywhere near the well-beaten tourist track that is Phuket. This made me somewhat apprehensive before our departure; but luckily all this melted away (making room for some much needed rest and relaxation) within minutes of arriving at The Pavilions. Perfectly situated somewhat north of the island of Phuket, it is well-clear of the chaotic touristy areas surrounding Patong Beach - but relatively close enough of a commute if you still wanted to go there. Also, this hotel does not cater for families with young children which - and don't get me wrong, I love kids! - makes it an ideal setting for those looking for a spot of tranquility and maturity that only a child-free setting can provide.

Our Villa was wonderfully spacious, very well-appointed and tastefully furnished. We had an infinity pool with breath-taking views of the ocean and the weather was perfect for taking a dip any time of the day or night! The open-air breakfast lounge provided an amazing soul-lifting back-drop to enjoy the very tasty breakfast each morning. Although not as extensive as your average 5-star hotel breakfast buffet; each item had been thoughtfully selected, providing guests with a "best of" range to choose from, with the main items (e.g. eggs, waffles) offered from an la carte menu and thus made fresh to order. The French toast and green mango smoothie made a particular impression on this foodie's tastebuds! We ate at their signature restaurant 360° twice - again, spectacular views of the surrounding hills and ocean provide a wonderful ambience to sample a fusion of traditional and modern Thai food. Other culinary delights of note are the Pavilion Platters that can be ordered to your villa to enjoy as a snack by your pool or on your sun lounge - we tried both the Savoury and Chocolate Fondue Platters and highly recommend both!

I also tried two of the spa treatments: a traditional Thai massage and an Aromatherapy Oil massage - both of which sent me to a completely different, blissful place; I cannot even find the words to portray the experience with justice! Le sigh!

The staff at The Pavilions are extremely professional and discreet; but still manage to genuinely portray the hospitality of Thai culture with their warm smiles, greetings and interactions such that one feels like they are returning home every evening, rather than as a guest.

In conclusion, a word or two on Phuket as a destination. It's easy to see how a well-travelled continental drifter may view Phuket as a predictable destination, not worthy of exploration - particularly if you do go to areas that are jam-packed full of tourists and families that have obviously come on one of those "kids stay, eat, and play for free" budget holidays (nothing wrong with that at all - just company who may not be to everyone's taste). I will be the first to admit - we came to Phuket specifically knowing that we would get more for our dollar than travelling virtually anywhere in Australia - and would be able to stay in luxurious accommodation at a fraction of the cost. Herein lies the challenge for you as a traveller, to create your own unique experience away from the beaten track. I believe that staying in a boutique hotel away from the main tourist areas, like The Pavilions, will serve an ideal setting to help you appreciate this beautiful part of the world. I also highly recommend hiring a car and Navman while you're there to get around - it's so easy to drive here and it means you're not tied down to doing set day-trips with tourist companies. Drive to a fishing village to meet the locals; or have a picnic on a secluded beach - the staff at The Pavilions are more than happy to give you directions. Another activity that I highly recommend is learning how to scuba diving and taking a diving trip out in the Andaman Sea - there are some gorgeous diving sites, the water temperature is warm all year long and the big bonus of course, there will only ever be a handful of other people joining you on these trips!

Scuba diving

2011-04-14T01:20:00.014+10:00

This weekend and last, my dad and I completed an Open Water Scuba Diving course. This is something we've both wanted to do for a long time, but I've kept putting it off because of time constraints, plus I had an inkling of reservation about the (lack of) sense and sensibility involved in plunging oneself deep into the vast, vast sea....

Anyway, at the end of last year, while on holiday in Jordan's coastal town of Aqaba (on the Red Sea), we took an excursion on a submarine boat with a glass hull that allows you to have a sneak peak at what lies beneath in the comfort of a dry and controlled environment. The submarine boat passed by a group of scuba divers on its course and I remember thinking to myself, "Far out, that's where the real fun and adventure are!!". It looked so free and liberating that I resolved to get my diving licence the first chance I got.

Watching divers from inside our submarine boat in the Red Sea, Aqaba Jordan

We booked with ProvDive in Coogee literally the week before starting the course as they had a one-off half-price offer. We were given a book and dvd to work through before starting the course - I found it really quite useful and informative learning about some of the theory of diving principles before even trying it; and the prac components made sense quite easily after that. We hit the local swimming pool for our first session in scuba gear to familiarise ourselves with some important safety elements like how to breathe using the scuba system; finding your regulator (breathing device) if it falls out of your mouth; sharing air with someone using the second regulator if you or they run out of air; clearing your mask if it fills up with water while you're under, etc. It was weird at first, that's for sure! Nothing was difficult per se, just a matter of adjusting your body, equalising pressures, and the number one rule: remembering to never stop breathing!!

Our first open water dive was out at Gordon's Bay last Sunday - I couldn't have picked a better day or site for the occasion. The weather was absolutely gorgeous both in the water and out; and the visbility was a fair 20 metres or so. It's difficult to describe the sensation in terms other than "like flying through water". I was warned by the guy who booked our places in the course that it's an addictive hobby - I can vouch for that! It was just as I imagined it would be and better. The silence, tranquility, and sheer beauty of the underwater world made me feel so calm and at peace; corny as it is, I kept humming Nina Simone's "Feeling Good" in my head.

Gordon's Bay, Sydney

The other thing that I loved was the commraderie among our team and enthusiasm of our dive instructor. There were nine of us in total: my dad and I; a law student about my age and her mum; a cute young Ukrainian couple; a cool surfy couple and a guy of New Zealander Maori background who wanted to learn to spear fishing while diving. We all came from different backgrounds; but between us a common desire to travel and explore the world around us, epitomised by our dive instructor - a young, hip Danish guy who left home in his twenties to travel, got his diving instructor's qualifications, and never made it back to Denmark. Le sigh! The life of the young and free! I mean, I'm young right (turning 25 this year); but by God, let me just say that the further along medical training I go, the more restrained and tied down I feel. Once upon a lifetime a ago before starting medical school, I just wanted to travel, drifting from place to place - taking my skills with me wherever I went. I was always going to be either a teacher, doctor or nurse for this vision to work; as these professions would equip me with portable skills that are universal across all borders. Fast-forward to the reality that is medical training and my prospects of continental drifting any time in the next 10-20 years are looking quite grim. I'll leave a complete and unabridged rant on this topic for another day; but let's just say, although I thought I could rise above and conquer this long-held silly dream of mine, it's getting the better of me and I am presently giving a lot of thought to what I'd like to specialise in based on it. Anyway, another thing I was also quite surprised by, was the inclusiveness and unpreteniousness of the diving community and their culture. They genuinely want people to learn to dive and be excited about the underwater world - and it's not financially driven either. When the costs of equipment, staff, insurance, licencing, etc are factored in, I doubt much if anything at all is made on leading a diving trip or teaching a "learn to dive" course. I could explicitly spell out a comparison to the culture of the medical community at times; but you all know where I'll go with that one. Hmmm...

So after our first weekend of diving, this weekend couldn't come sooner. We had another geat couple of dives, this time out at Camp Cove. The weather this weekend was a bit miserable, but when you're underwater, you're going to get wet anyway! We finished our course and I have to say I was sad at having to say good-bye to my diving buddies. Le sigh, such is the nature of transient friendships; but who knows, it's a small world and our paths may cross again on day, on land or in the sea.

As for my dad and I; our holidays have just gotten all the more exciting and fun!! Our first chance to put to practice some of our newly acquired aquatic skills will be this upcoming week. My mum, dad and I are off to Phuket for a week over the Easter long weekend and I can't wait to get into the water and check out some of the amazing tropical reef and sealife up there. Hopefully will get a chance to take some photos while down there too! In closing, I'm going to highly recommend y'all get out into the water and try diving for yourselves. You'll be amazed, I promise!

Break-it-up

2011-04-04T21:02:00.004+10:00

I have a load of uni work that is quickly piling up into a mountain. 11 weeks into the (17-week) semester, I'm thinkin', "crap! what have I been doing all this time?!"

Doesn't help that, mentally, I just want to cruise through this year and put in the bare-minimum of effort required to scrape through. Still, it's dawning on me, "scraping through" still requires public health assignments to be handed in; journal club papers to be presented; and short-cases to be reviewed. Urgh!

One of the habits I've had to get back into practicing, is breaking tasks up into bite-size chunks, and chipping away at a seemingly overwhelming workload one bit at a time.

God that I wish for this year to pass painlessly! Pleeeease!!

In other news, today as I was walking to the train-station, I found myself becoming a nosy-onlooker at the scene of a car vs pedestrian accident. I watched with much apprehension as the ambos scooped up this poor semi-conscious woman (who was just innocently minding her own business, crossing the road at a pedestrian crossing, as you do..) and whizzed her off to hospital. I considered for a brief second running back up to the hospital (I assume they would have taken her to my clinical school hosp; which was only a few hundred metres from the scene of the accident); checking out her management in the ED and seeing that she was okay. But the sight of the pool of blood that was left on the road from her open head injury made me feel quite queasy.. and honestly, I decided that I preferred not to know the outcome, if there was a chance that it was going to be a bad one. *Shudder!* Anyway, I now have a renewed sense of utmost respect and admiration for ambulance officers.

Okay, enough said - time to hit the books!

Inspirational: Dr Susan Downes

2011-03-30T23:31:00.007+11:00

I came across Dr Susan Downes' story as I was browsing the net this evening, searching for some career inspirations (as you do). She is a GP-Obstetrician who delivers services across a huge expanse of land in Western Australia (extending as far out as Christmas and the Cocos-Keeling Islands in the Indian Ocean!!).

The following is an article that was featured in Medical Forum WA Magazine (April, 2006). I hope you enjoy reading about her story and find her work as inspiring as I do!

Multiskilled - Dr Susan Downes
Written by Mark Thornley
Saturday, 01 April 2006

They say the genes for multi-tasking, negotiating skills, spatial awareness and acceptance are carried on the X chromosome. Dr Susan Downes is living evidence of these inherent skills, plus more, having pursued a varied career in primary health care while raising three children. Her ability to thrive on diversity, adapt, and break down boundaries has positioned her as an every day pioneer in primary care. Susan was a wide-eyed epidemiology research assistant before she took up medicine at the age of 35. She has excelled since, undaunted by family trauma, and this year her remote GP work in the Pilbara and on Christmas and Cocos Islands earned her the General Practice Prize for Excellence in Population Health, conferred jointly by The Public Health Association of Australia and the RACGP.

Dr Susan Downes on her RFDS run

A self confessed travel junkie, Susan has always had a curiosity for new cultures.

"When in London I was working with many epidemiology doctors who inspired me with their stories of different countries and cultures. One in particular had worked in New Guinea and told me how he had to do a caesarean on a tribal chief's wife who had obstructed labour with twins."

"The tribe was cannibalistic and he was thinking, ?if this doesn't come off, I'm on the menu for dinner'. He'd never done it [a caesarean] before and was reading the medical book and was on the pedal radio trying to get instructions."

Flicking through an international medical journal and drooling over jobs for medicos in exotic locations, she decided to enrol in medicine as a mature age student.

Her actual medical career began as a family GP in Fremantle where her strong connection to people meant it was not long before she knew the names of her patients' budgerigars and was "burying their grandmothers".

The multicultural Fremantle mix of Greek, Italian and Portuguese provided a solid grounding for her transition to the Rural Women's Female GP Program that now sees her consulting Malay, Chinese and Muslim communities throughout Christmas and Cocos Islands.

"I felt I was becoming a bit narrow in the suburbs and just filling out forms and sending people off for blood tests. When you're out in the sticks you're doing everything yourself. You're reading your own x-rays, and doing your own bloods and ultrasounds."

She now incorporates Chinese medicine and Aboriginal bush medicine into her consulting, where she can. She thinks any GP who takes on a rural locum might regain some of their inspiration, especially away from bureaucratic hoops.

For example, she recalls one confronting incident on Christmas Island, which is so remote even the Royal Flying Doctor Service cannot attend patients unless they charter a special plane.

"We had a fracture-dislocation of the cervical spine. No plane could come and the paralysis was getting worse as we watched him. A community plane that used to go to Jakarta happened to be on the island so we took the seats out and a nurse and I got on with the patient and the pilots, and set out into the Never Never and flew to Perth via Learmouth in the dead of night. We really felt we weren't going to make it but eventually we got the patient there and he went into theatre straight away and is now walking."

Susan has been attending the health needs of adolescent Aboriginal women in the desert communities of the East Pilbara for five years. She visits these communities for 2-3 days every two months where she confronts sexually transmitted infections, unplanned teen pregnancies and cervical cancer.

To do this she must gain the trust and confidence of these shy groups of women, where she helps deliver education programs at medical centres, schools or even creek beds and swimming holes.

By preventing STIs, future infertility and its expensive solutions are greatly reduced. By encouraging pregnancy-free years, young Aboriginal women mature physically and mentally and attain higher levels of education.

Susan's involvement as Liaison GP at Woodside Maternity Hospital has ensured the hospital's status as the last inner suburban hospital to retain a thriving public obstetric service run by GP obstetricians. Deliveries have risen 12.5% and she assumes a senior role in a team delivering over 700 babies each year. Susan now performs her own caesareans and can offer the full obstetric service in remote locations such as Derby where she does obstetric locums.

Twenty-one years after entering medicine, she had recently completed an obstetrics research project and hopes this, plus her work with the WA Centre for Rural and Remote Medicine, will help others providing obstetrical services in remote communities.

Enjoying bush walking and bee keeping as hobbies, she has a long term goal to work for Medicine sans Frontiers or Oxfam - when she gets enough money in her super fund.

(http://www.medicalhub.com.au/, accessed 30 March 2011)

I'm trying to locate her contact details so as to send her an email and ask if I can do an elective with her at the end of the year! Would be amaaaazing!!

Full-time all the time

2011-03-29T23:39:00.000+11:00

Random rant that I feel strongly about, so just put up with me for a few minutes here.

Dear Stay-at-Home Parents (who think that only they can exclusively call themselves "Full-time Parents" and feel that they have the hardest and most important job in the world),

I'm sorry to break it to you, but you don't. In fact, you only have half the job that some others do. Because - believe it or not - parents who participate full-time in the workplace, do not come home to part-time parenting. No, in fact, they come home to full-time parenting: the same job that you do all day, they do when they come home. So they essentially have two full-time jobs. It's called "Time Management".

I understand that you may be frustrated by the lack of recognition and financial reimbursement of full-time parenting, but here's the thing: it's even less valued and recognised as an occupation if you are a full-time participant in the workforce, because there is the assumption (by a select few) that you cannot be a full-time parent AND a full-time worker. So they take claim to the title of "Full-time Parent" and take it to define only those who do this exclusively.

Oh, and another thing, if full-time parenting was financially reimbursed - I bet you anything that parents who are also full-time participants in the workforce would be excluded from that payment. And you'd all be okay with that. So go figure.

Anyway, just putting it out there for the next time someone starts giving me their spiel about how exclusive full-time parenting is "the hardest and most important job in the world".

End rant/

GAMSAT Version 2.0 and "meh" talk

2011-03-27T23:29:00.010+11:00

Weekends always go so quickly. What's with that..?! I had a very bizarre experience this weekend. I did St John First Aid duty for the GAMSAT exam (Sydney Venue). It was so weird right. Last time I was there was four years ago when I was sitting the exam myself. It's funny how even the memory of a high-stress situation can provoke the same sympathetic response as the original event. I so vividly remember not being able to sleep the night before the GAMSAT - I kept dipping in and out of consciousness, checking the time on my mobile phone next to me every half an hour for fear of sleeping-in and missing the damn thing. Not to mention the drum-roll palpitations on entering the exam hall. It's such a b*tch of an exam and I honestly see no correlation between passing the exam and success in medical school. It really is just a high-attrition tactic to wipe out > half the med-school hopefuls so that the bureaucrats and admin people don't have to deal with the effort and paper-work of going through all the potential applications that would come through. Meh. Anyway, thing of the past, can comfortably put it behind me and was oh-so-very relieved to be there as a spectator at the Australian Technology Park in Redfern (venue where the exam is held) this time.

On the med-school front, I finished my rotation in Neurology last week. It was a really good rotation; made all the better by the team I was with and my supervisor. I definitely could have been more pro-active and involved, but I seemed to always find the temptation to go home after lunch too strong to resist. So basically I'd attend ward rounds in the morning; then tag along with the registrars on their consults (usually in ED); there would always be a meeting of some sort that was worth attending (especially the radiology ones where they go through scans of patients on the wards); some days there would be a clinic on in the morning or afternoon; and the rest of the time was spent seeing patients on my own or with another student. I tried to see at least one patient a day and do a long-case type assessment of them. Sometimes the interns would ask us to take bloods or put in cannulas which I'm a bit over doing now because the novelty has worn off, from doing so many last year. Anyway, there were four medical students on the team - one of whom was a bit annoying because she would always hang around until really late into the evening with the team. She's interested in pursuing Neurology as a speciality, so I understand that she wanted to get as much out of the placement as possible; but still, it made us all look unmotivated and less-than-keen. It was a bit frustrating too because she would never explicitly answer my questions on what she would get up to in the afternoon/evenings when we weren't there; so it was hard to gauge whether it was worthwhile staying behind or not. Of course we could've just stayed behind ourselves and found out, but I don't know that it would have really been useful as most of the activity seemed to happen during the day, and she would always slip off and do her own thing anyway. Meh. I'm sounding a bit like sour grapes now, so I'll stop. I am actually happy that she's thrown herself into Neurology. Two reasons: (1) every speciality and its patients deserves to have a keen-bean enthusiast who will throw themself into their work - these people turn out to be the movers and shakers of the specialy; (2) last year she was set on pursing O&G, so she would have made some very stiff competition if we were going for the same registrar-level training position. Okay, official freak of sour-grape I am today - will stop! So, um, yeah.. I always assumed I'd fall into a career Neurology myself, because I have a degree in neuroscience - so it seemed like a natural progression. I have to say though, the fascination and general awesomeness that drew me to the theory of neuroscience back in my undergrad days; is numbed by a sobering overtone of helplessness when it comes to the actual clinical practice of Neurology. There really isn't much that can be done for a lot of patients under the Neuro or Stroke-Unit teams, curatively - with the majority of management aimed at stopping disease progression or rehabilitating the body back to a functional state, post-event. The true hero(es) in my eyes, are the clinical research teams that are working on preventing and/or curing neurological diseases. I hope that I can see their effect of their studies in my life-time. It really would be an amazing contribution to society.

Tomorrow I start the last of my medical/surgical "selective" terms - Gynae Surgery. I had initially been timetabled for Haem Oncology, but I heard it was a fairly average term to do as a med student, so I swapped out of it. The person who was assigned to Gynae Surg has no interest in this area at all, so she was happy to take anything else. I'm thinking again about going into O&G, so I guess it was a win-win situation. I've heard the supervisor for this term is really nice, but he grills his students on their knowledge of the anatomy of female reproductive organs. So I spent like maybe half an hour (if that) trying to memorise the ligaments that hold various different things up and stop them from falling, if you get my drift. I think I'm okay getting grilled for the first week, and then getting the swing of things by the second week, because I'm honestly finding it too hard to just stare at diagrams of the uterus and ovaries without a clinical situation to slot things into context.

Anyway, it's now midnight and I'm wishing I had more weekend time to catch up on sleep, chillax, watch some DVDs and do some uni work. Meh.

Long-lost friend

2011-03-10T00:51:00.006+11:00

I haven't blogged in a long time. I haven't even read other people's blogs in the time being :-S Of late, I've had a bout of avolition where I've just found it hard to get on with the easiest and simplest of tasks. It hasn't helped that I've had deadlines to submit various forms coming at me left, right and centre. It's paper-warfare I tell ya! So, since November, here's what I've been up to (in a nut-shell):

- Sat and passed end of 3rd year exams (phew!). Actually did aright, I got an overall mark of 76% which is the highest I have ever gotten in med-school so far as an end of year grade.

- Travelled for 2 months to Jordan, Syria and England over the summer break (although it was actually winter in all of these destinations). I had an amazing time and definitely could've kept going with my continental drifting had I not had to come back to start 4th year in late January (I actually missed first week back, so go figure). I did some hospital placements while I was oversees (O&G in Jordan, ED in England) but have nothing remarkable to report on those execpt that they were pretty boring, uninvolved and student-unfriendly. This turned out to be a good thing as it meant that I was okay not being at the hospital and actually doing some travel.

- Returned in late January to commence my 4th and final year of medical school (*squeal!*). I'm so excited to be on the home-stretch run. This has been a long time acoming! I will have plenty more to write about this as the year progresses, so it's definitely going to be an overriding theme throughout my posts this year. As for what I have been up to rotations wise, I am half-way through my 2nd rotation (Neurology). My first rotation was Cardiothoracic Surgery (this is something I plan to write more about as well in the near future) - but suffice to say for now that it turned out to be the highlight rotation of my med school career so far. Bloody mind-blowing, complex, intensely emotional cases - the grand dame of surgical specialties did not fail to impress! Neurology has been quite cruisy but enjoyable as well. Kind of my niche area if I had to pick a medical speciality as I did my undergraduate degree in Neuroscience.

- What else? I was made redundant from my long-held (9 years!) job before going overseas. This is something that stressed me out a great deal, especially since I have a maasive loan (~ $20 000) that I took out to buy my car last year... and also because I was just about to go on holiday and the last thing I wanted was to do things on a shoe-string while travelling. Anyway, I dug deep into my savings and managed to budget what I had quite well while on holiday. As for my car, I lent it out to my parents (who sold their car at the end of last year and didn't yet get a new one), while I was o/seas and they paid my fortnightly loan repayments in return. So then when I returned from overseas for the first month I just made do with what I had and brought lunch from home and didn't go out at all, etc. Then I found a tutoring job which was advertised on Gumtree, basically just helping a mature-age "return to uni after having kids" student from a non-English speaking background with her assignments for a Bachelor in Early Childhood Teaching (very random, I know!). It's a few hours work so it's not too bad and it's cash-in-hand. But get this right, in a fortunate twist of fate, my ex-work contacted me last Sunday about getting my job back because they'd culled too many people and were in desperate need of staff that they wouldn't have to retrain. SO now I've got my old job back (on a Sunday too - so extra pay!) AND I have this random tutoring job, which means I've gone from just Youth Allowance income, to > double that every fortnight (and all is well with the world!). This is has been a big relief, especially since I would like to save up to travel at again the end of this year.

- Lastly, my sister is now about 21 weeks preggers and getting quite big. Her and her hubby want to keep the gender of Little Bambi (as I call It) a surprise. But I'm very much looking forward to meeting it and forming an awesome friendship with it later down the track!

So, that's it from me. I have a few things I want to reflect on, which I will do gradually. One thing I was thinking of doing is switching to a different blog as I feel like this blog was started in a time and place that I am far removed from now, and everytime I log in I think of all the crazy shit that was happening at the time, so it's not always a happy place to come back to. Still, it feels like a long-lost friend that knows all your secrets; but not in a snide way either. Anyway, I will give forwarning of a change if it does happen as I don't want to drop off the blogosphere and have people wondering if I got hit by a car or something :-S

Toodles!

Big dreams, little one...

2010-11-08T17:09:00.002+11:00

So I'm not supposed to tell anyone yet, but since none of you actually know who I am, I figured it'd be okay to spill the beans here:

I'm going to be an aunt!!

My sister just found out she's pregnant :-D I've just made room in my heart for some big-time love! In my collective culture, a new baby in the family is everyone's child and responsibility. So my sister having a kid, is like me having a kid. Wow! Totally unprepared for this but gosh, I'm so excited!! She's only 6 weeks, so plenty of time to start planning all the fantabulous things we're going to get up to.

Little one, you don't know it yet, but Aunt Purple Steth has some big dreams for you. You're going to be awesome, I just know it!

She's a real person

2010-11-02T20:47:00.002+11:00

I hope I never become jaded. I hope I always remember that patients are real people and not a disease embodied. It sounds a bit obvious - but those in medicine will be able to relate. You spend the first couple of years of med school reading and learning about a multitude of diseases and pathologies. Some of these are essential knowledge; others are vague differentials you push to the back of your mind because you know you'll never see a case like that. The so called "you'll only find it in a text-book" cases.

Today I saw a lady who had a transverse myelitis and radiculopathy due to a Coxsackie B virus. My clinical partners and I took a group history and exam; I thought she had Guillain–Barré syndrome - she was almost paralysed from the umbilicus downwards. It's pretty scary shit actually, and something you probably won't even read about in a text book it's that uncommon. As we were coming to the end of our examination, I looked up at her and thought to myself, "oh my, she's a real person..".

It's this crazy weird moment that hits you. I've had it happen to me before. On the one hand, it leaves you feeling so inadequate and unworthy of the privilege bestowed upon you by this person sharing their misfortune; on the other hand it leaves you with this fierce desire to repay them, to be useful, to have an answer or something that you can offer them. It doesn't happen with everyone; I guess the mental struggle involved would be somewhat counter-productive - you can't invest too much. But it's a nice reminder that crops up every now and then. Medicine is about real people.

Things are pretty good at the moment :-)

2010-10-24T19:37:00.003+11:00

Dear Blog,

I'm sorry I abandoned you. I have so much to say and yet time - as it always and forever will be - is against me. I've finished O&G, general surgery, paeds and am now on the home-stretch with 4 weeks left of general medicine.

O&G was amazing, but very tiring! I have so much admiration for the registrars who continue to pull through restlessly, day and night. It's an incredibly rewarding speciality and I wish I had the energy to pursue it, but I honestly think that the long hours and exhausting on-call roster would get the better of me. The other thing - more than ever, I've renewed my resolve to work in medical aid work (I'm counting down the years until I'm capable of being able to stand on my own and contribute productively in the field)- and I have a feeling that gaining a fellowship in O&G from here would equip me with more skills that what I would need in a developing world setting. Seems a bit redundant being able to perform IVF and high-tech laparoscopic gynae surgery when what I essentially need to know is how to deliver a baby safely and do an emergency hysterectomy (as a last option to resolve PPH). So I've reset my aspirations and have rechanneled my plans towards becoming an Emergency Physician with a Dip of O&G. I'll write more about it later on, as things progress, and especially during/after my ED term next year, but for now, I'm excited once again. Excited about being in medicine and where it's going to take me. Hip hip hooray!

The other thing I'll mention is how much I enjoyed Paeds! Absolutely loved it and the characters along the way. The Paeds registrar in particular was so enthusiastic and inspiring; her work-ethic really came through and she went out of her way to make sure we (the students) were included in the team.

So 4 weeks left (then 1 week of stuvac and 1 week of exams). I can't believe how quickly this year has flown by! I'm on the homestretch folks! In 6 months I'll be applying for a job; then 6 months after that I will be on my final elective rotation, a few weeks off from finishing. I hope it's come through in this post, but if it hasn't I'll spell it out: I'm really happy, I feel at peace. I'm starting to see the light at the end of the tunnel and feel less like an aimless wanderer than I did when I first started almost 3 years ago. I've learnt a thing or two along the way, and I have a sense of direction of where I'd like to go with this knowledge. If you're reading this and you're still at the beginning of the journey: keep at it. It's seemingly long and endless, but oneday you will reach a point where you can not only look back and marvel and how far you've come; but also look ahead and feel that the road ahead isn't as daunting as it seemed when you first started and that there's no where else you'd rather be than where you are at that point.

In Condé Nast, we (would like to) trust

2010-08-03T00:23:00.007+10:00

I'm going overseas from December-January for a combined holiday/elective placement. I'll be spending December in the homeland (Jordan) and January in the UK. Most of my time in the UK will be spent in Manchester where I will undertake a placement in emergency medicine at a BTH (this will be in addition to a placement in O&G in Jordan). I then plan on spending a week in London, for obvious reasons (can't go the UK and skip London, especially if you've never been there before!). So far, I've organised the placements; arranged accommodation in Manchester and Jordan (I'm really just going to be alternating between the hospital accommodation and my uncle's place on weekends for Manny; as for Jordan, well, it's the "homeland" with all that that entails :-P); I've booked my plane tickets and now just have to organise accommodation in London. Which brings me to the topic of this post.

I want to do London properly. Not on a shoestring. I've heard it's such a grand old city with lots to see and do; so even though I've only got a week there, I want to get the most out of it... and I want to do it in style. My backpacking days are over - I'm going to be earning a half-decent income in less than 18 months' time so I think the time has come to stop worrying about putting aside what meager income I'm making from my casual job + youth allowance for "a rainy day", and start spending some of it. In my quest, I've had to exchange my trusted Lonely Planet advisers to Condé Nast Traveller gurus. Oh to be a Condé Nast Traveller reporter! Forget Runway Magazine, this would surely be the job that a million girls (and guys) would die for! I've spent a bit of my free time over the last couple of days perusing the "Where to Stay in London" section on the website. Some of the places look so amazing, I honestly just wish that money wasn't a limiting factor and that I could stay wherever I liked. I'm determined to have a nice classy experience but cannot by any means justify (or afford) the $500+/night tariff on most of these places. So now I'm in a bit frumpy mood because I'm stuck in the middle - neither here nor there - annoyed with myself for trying to be pretentious beyond my financials means, but also at these hotels for being so ambitious in their room rates. Moments like these I really feel for people with Bipolar Disorder. Urgh! Anyway, will reach a happy medium soon I hope, and then update.

Chance Encounter ("Paradoxically" Part II)

2010-07-12T17:15:00.008+10:00

The more people you encounter as part of your routine ongoings in medicine, the more people you forget (inevitably, due to statistical likelihoods and all..). Every now and then you meet someone memorable and sometimes find yourself thinking, "I wonder what happened to..?". This is particularly the case, I think, in emergency medicine where the duration of a patient encounter will total a few hours, if that, and then the patient is transferred to someone elses' care, discharged home or (as the case has been for several of my patients), taken from us by the Almighty upstairs. So, this afternoon at the dentist's, I was presented with a chance encounter of the fateful type - I was reunited with the wife of the gentleman who died of a cardiac event a few months ago while I was doing a night shift in ED.. the one whom I had informed of her husband's passing on that tragic night. She recognised me before I had even noticed her standing there, and then when I looked up and saw her looking at me, all she had to say was, "my husband.." for that night to come rushing back. It wasn't an unhappy encounter and not completely awkward like you would expect it to be, but there was certainly an air of unease as we exchanged our greetings and how do you dos. I found it hard to tailor my body language appropriately to the situation - should I smile? should I sigh? should I just nod curtly to everything she says? How on earth does one converse to a deceased patient's family members, many weeks post-mortem? She talked about his death and how the hurt hadn't eased one bit - certainly her affect and tone were as sorrowful as that night, and the painful self-imposed guilt was still there: "if only we'd gotten him to the doctor sooner, if only...". We also talked about the coroner's insistence on an autopsy despite the family's wishes for an immediate burial and other smatterings of small chat, as you do. She cried, I listened and offered her the untested advice that it will get better one day. So then we went our seperate ways, wished each other well and hoped for another chance encounter. A small step towards closure that is often missed in this profession, a little poetic too, don't you think?

Handbags

2010-06-25T19:47:00.004+10:00

There's something about patients' handbags which remind me that before me is a person, and not just a body. You can put all sorts of things that signify life and existence in this world in a handbag: keys, wallet, tissues, mobile phone, diary, random hard-boiled candies wrapped in clear cellophane... you get the point. A few weeks ago, a dear old lady in Ward C passed away. Her handbag was always at the foot of the bed. After the arrest call and proceedings, as the people in the room started to clear away, I noticed that her handbag was still there by the foot of the bed. And then I couldn't help but wander about how her family would feel taking it back home without her. It made me feel quite sad at her passing, even though I'd only seen her a few times during ward rounds. She was a person, with a handbag full of worldly things that are of no use to her in the next journey. And by then, neither are we...

Paradoxically...

2010-05-25T00:17:00.009+10:00

Saturday morning, 3.30am, overnight shift in ED. I had just gone into the on-call room for a shut-eye when one of the interns popped in to let me know that the ambos were bringing in a middle-aged male in cardiac arrest. There was six of us in ED: an ED physician, 2 interns, 2 nurses and myself. Did I want to see it? "Hell yeah!" I thought, this is the only medicine worth seeing as far as some med students are concerned. Things are somewhat different on the other side now, you'll see what I mean.

He looked his age, but a little worse for wear. He'd been intubated by the ambos; and had defib pads on his bare chest. I stood back to watch as the scene unfolded, wanting and unwanting to be involved... it's a hard feeling to describe. A few minutes in, one of the interns told me to grab a pair of gloves and get ready to take over chest compressions. "Wha..? Err, okay.." I took over after from the start of a new cycle - and in that instant, I crossed the line; I became involved, in more ways than I wished to be, as events would later unfold. I'd done CPR before - on a 90 something year old already half-dead, dying old man in Fiji, just because protocol dictated we do so. At the time, I appreciated the practice, felt kind of sorry that I broke his rib cage, and was secretly grateful when they called it. This was so different, so much more intense, so much more involved... I'll keep coming back to that word. It was an intensely highly-sensory experience: I could smell the patient's sweat; hear the ventilator beep, puff and whirrr; feel the crunch beneath my hands as we'd surely broken his ribs; and see his empty eyes staring up at me. If anything, the eyes gave it away - he wasn't going to make it, even I knew that. In hindsight, I wish I didn't have that initial hunch that he'd already left us - I wonder if I would've compressed harder and more wilfully on his chest if it weren't the case? I wonder if that would have made a difference? Several rounds of compressions, a bolus of atropine or adrenaline, stop and re-assess, rotate through and do it all again... we gave him a fair go. Initially because it seemed he was gasping for air though the ETT, and then when that had stopped, for closure. And then we called it, just like that. Machines turned off, ventilator detached. Time of death: 04:05.

We stood back for a few moments to quietly reflect on what had happened and pray to whatever we believed in that he was is a better place now. Then one of the nurses looked up at me and said, "he's from a Middle-Eastern Muslim background, I think the family would really appreciate if you're there when Noel (the ED physician) tells them." It wasn't a suggestion, they all nodded in agreement and it was decided. Nothing in the world can prepare you for delivering the information we were about to. Nothing at all. We lead them into the family room - his wife, kids, brother and sister in law. Typical Arab-style, the extended family were all in the waiting room. Noel started to ask a few questions about how our patient came to be: straight-out-of-a-text-book heart attack presentation - so classical, it was heartbreaking. His wife recognised he was having a heart attack and urged him to go to the hospital. Shit! If only... ? Or maybe it wouldn't have made a difference... ? Who knows... ? Noel asked a few more questions, before finally putting it out there that, "we tried very hard..". The message passed over them. Noel looked at me and I said in a faint voice in Arabic, "God has taken his soul, may He have mercy on it".

The rest is of inconsequence. Life happens when you least expect it and people react in ways that they know how best to. The outcome is the same, no matter who delivered it, but I hope that being there in this sensitive moment made the situation a little bit easier for them. For me, suddenly, everything else in the ED that night seemed so trivial...

To be honest, I hated being the bearer of bad news to this family - worst feeling as far as the future doctor in me was concerned; more so than losing the patient I think. This family could have been mine, easily; the situation was so eerily close to home after what had happened with my mum last year. I was involved in a way I haven't been in a very long time, or ever even, with a patient and their family. But there's a lesson to be learnt in everything we do here. In the past few months before this happened, I'd noticed myself becoming increasingly blase about the people around me as patients and my role as a carer. A lot of the time I haven't even bothered asking the patient's name and I guess I've pushed this concern to the side thinking, "detachment in medicine can only be good", or they say so anyway. And then this. I won't deny that I've felt quite sad for the last few days, but now that the dust is starting to settle, I feel refreshingly at peace with the idea that I've at least felt something towards someone who I was looking after. It's paradoxical, I know. Guess I just didn't realise how much I missed it...

A rough patch on the greener grass

2010-04-28T23:18:00.000+10:00

Half-way through my GP-rotation and the honeymoon period is definitely behind me. I never expected my GP-rotation to be so exhausting. This is really due to my main GP supervisor, who is just...so... mean! Today I cracked it. Today she made me cry. I'm too exhausted to write about in great lengths; she is simply just so exhausting! I wrote to the clinical supervisor/mentor of my home-base hospital asking for help:

Dear Mentor,

I hope you're well. I'm half-way through my GP rotation and wanted to raise a concern I had with one of my mentors. I have several GP supervisors that I work with in the practice - all of them are really wonderful and I love working with and learning from them. My main mentor, Dr X, however, is really quite harsh and strict. Her feedback is extremely helpful - don't get me wrong - she gives great advice about what you need to know to fill gaps in your knowledge; but her approach and mannerisms are quite destructive. If she asks a question and you don't know the answer, she pulverises you in front of the patient and makes you feel like a failure. I don't know if I'm just a little soft in that regard, but some of my experiences with her have been extremely stressful and quite frankly, just downright hurtful. I've been too scared to say anything to her about it because, all things standing, I think she means well and it's certainly not personal. On the contrary, I have thanked her for her feedback and am doing my best to remedy these gaps in my knowledge. But I still feel really upset about her demeaning approach and I'm not sure what to do. I know we're half-way through and if I can disregard any of my personal response to her approach, there is a lot to be gained from the wisdom she is offering. I was wondering if you can offer me any advice on how to approach this situation? I really want to learn from her; but at the same time I don't want to go home crying every night.

Thanks for you support,

Miss Purple Stethoscope

She replied straight away and told me she'd call me tomorrow to have a chat about it. Very, very grateful for her support; but still feeling stressed-out that this chat will come after a day spent with Dr X and God knows what sort of damage she'll have done to me by then. Thinking of having a mental health day tomorrow, but also feel deep down that it will be like admitting defeat. I know it seems excessive, but I've been tipped over the edge. And I'm a fairly tolerant person... if that's saying anything...

GP-Land...

2010-04-13T23:10:00.001+10:00

... is a happy place, with candy-cane and fairy-floss; oh, and no ward rounds or running around a hospital trying to find people: the patients come to you - fancy that?! ... bliss!

***

*Snap out of day-dream for a bit*: I just found out this morning that one of the students doing the John Flynn Program has been placed in the Cocos Keeling and Christmas Islands! OmG! Extremely jealous!! I do love my rural community of Mudgee very much, but c'mon - outback NSW vs Islands in the middle of the Indian Ocean?! Hmmm, at least I now know it's a rural area of need that I can (and will!) venture to in working off my rural bondage.

OK, back to daydreaming...

Dear FMH,

2010-04-12T21:56:00.006+10:00

I miss you everyday.

Come up to meet you, tell you I'm sorry
You don't know how lovely you are.
I had to find you, tell you I need you,
Tell you I set you apart.

Tell me your secrets and ask me your questions,
Oh lets go back to the start.
Running in circles, Comin' in tails
Heads on a science apart.

Nobody said it was easy,
It's such a shame for us to part.
Nobody said it was easy,
No one ever said it would be this hard.

Oh take me back to the start.

~ Coldplay, "The Scientist"

Learning how to be a doctor, one step at a time

2010-04-10T20:36:00.003+10:00

Saturday night; interim weekend between two rotations. I've just finished the first of my two Surgical blocks (plastics and ortho) - the next one (gen surg) I will do later this year - and am about to start my General Practice block next week. Surgery was pretty awesome, plastics more so than ortho. Despite the early morning starts, the day went quickly as there was lots to do and we normally didn't stay past 5pm (though the surgeries would go past 10pm most nights). There was a pre-med student from the USA doing an "internship" in orthopedics during our time there and she was such as eager beaver, coming in very early and staying late every day; which made us look a bit bad, but hey, it's not as cut-throat here so we don't really feel the need to exert ourselves to excel. My supervisors in both plastics and ortho gave me really positive feedback in my competency assessment form; I feel quite accomplished that after 2 years of getting mediocre marks, my hard work is finally getting some recognition! On a personal level, I feel like I achieved what I set out to do in this rotation in the way of practising my hx and ex skills as well as some basic procedures, particular to a surgical context. I now feel more confident with a lot of bread and butter presentations/skills that I will no doubt encounter again in internship and beyond. Small steps, long way to go.. but I'm getting there, I'm learning how to be a doctor and look after people. Damn it feels good!

Some reflections on psych and surgery

2010-03-31T23:29:00.004+11:00

Wow, I haven't posted on here in ages. It saddens me to think that I'm losing the ability to reflect constructively. I don't want to write about my trivialities just for the sake of it; so I guess I could also put my absence down to not having anything to reflect about. But here's a thought or two anyway, to fill the silence, if anything. So, of late, I finished my psych rotation and have started on surgery.

Psych was interesting, I learnt a lot, especially from my mentor who helped me see things with a bit more clarity, in a compassionate and pragmatic light, when all I could see before me was a damaged-beyond-repair, dysfunctional individual. It takes a very special group of people to be able to care about others in that way; and of that, I am quite envious. One of the things I didn't like about the psych rotation though was a particularly territorial (and often just downright rude) RMO - she didn't want students doing anything and would even tell us off for writing on hospital paper/progress notes! I hope her attitude damages her reputation when it comes time to apply for a training program. And that's all I have to say about that.

After psych I went back to my secondary home-base hospital to start on my surgery rotation. I did three weeks of plastic surgery there - which was everything I could have wished for in a rotation. The team I was attached to were amazing clinicians and teachers; and the RMO was just wonderful (*so* different to the psych RMO bitch). She was happy for us to get right in there and help out as vital members of the team. I got lots of practice in doing speedy histories and examinations when a plastics consult was called for in ED; interpreting hand x-rays (most of the cases where hand injuries); ward management of plastics patients; scrubbing and suturing; removing K-wires; as well as the usual cannulas, bloods and plaster casts. It was actually quite a refreshing change to go from the long-winded and twisted complexities of a psych patient to the straight-forward flow-chart style management of a plastics patient. Plus I loved being back in my home-base hospital: everyone is so friendly and there's this lovely feeling of comradery among all the staff. I have to say, these experiences are definitely steering my preferences towards internship at a smaller hospital in a couple of years (still too early to think about that though, so I shan't get ahead of myself).

Now I'm back in BTH to do two weeks of orthopaedics surgery (currently in my first week). It's been okay; I feel depressed about leaving my lovely plastics team, but that's not to say that I'm not getting along with the orthopods either. The consultants are very friendly and welcoming (one of them bought us coffee this morning before rounds) and are very happy for us to scrub in on their surgeries and attend their clinics. I scrubbed in on a total knee replacement today, which was tres cool and neat! I guess I don't really have a sensible explanation as to why I think it's "okay" rather than "great"; maybe it's just a relative thing, like, it's "okay" relative to plastics. The teaching has been pretty good though, especially from one of the registrars who (despite my annoyance at him calling me random names like "Billy" and "Med student no. 2" instead of my own name - wtf?!!) is kind enough to explain every process of whatever operation we're doing and talk to us about the presenting disease process. Anyway, I'm glad there's a long weekend coming up, I need sleep!! Will update again soon, tootle-pip!

Mentally Exhausted

2010-02-06T21:30:00.010+11:00

Having just completed the first week of my psychiatry block, I thought I ought to take a minute or two to reflect on the week's past events and experiences. On the first day of my rotation, I was assigned to work in the ED and PECC Unit (Psychiatric Emergency Care Centre) with the psych team at a big tertiary hospital (BTH) in a somewhat notorious area of Sydney. The other members of my group were allocated mentors in the actual psych ward to follow around/work with - I assume there will be a swap-over at the half-way mark so that we may experience both settings. In brief, the experience has been more exciting and yet more exhausting than I could have ever imagined.

My shift is from 2pm-9pm everyday - partly so my time wouldn't coincide with other students' from other years/med schools, and partly because that was the busiest period in the day for the ED psych team. My team look after people who present to psych voluntarily or are brought in involuntarily.

The voluntary patients form the minority of presentations. These are generally cooperative patients - mainly middle-aged business men and women, or young overseas travellers - who are facing acute psychiatric crises (anxiety, panic attacks, adjustment disorders, suicidal ideations) that they want immediate help with then and there. Once they're cleared medically by the ED doctors (all patients have to be cleared medically before being been by psych) the psych team has a chat to them (read: talk for over an hour sometimes) about what's been happening now and in the past; determine their level of "risk"; before deciding whether to keep them in for observation in the PECC Unit overnight or referring them to the hospital psych outpatient service.

Now, in mentioning that the BTH that I'm working in was in a notorious part of Sydney, I really meant notorious for the involuntary pscyh patient presentations. In NSW (and possibly Australia-wide), a person can be scheduled for involuntary detainment/assessment/treatment by a mental health team under different sections of the law. What that basically means is that if a person is deemed to be (acutely) "Mentally Disordered" or "Mentally Ill" and are at imminent risk of harm (to themselves, their reputation, others, or by others) - the police, ambulance, community, or medical practitioner can bring them into/make them stay in hospital for a period of time until further action for their management is decided, against their will (of course the finer points of this are many, I'm just trying to be brief). This is actually a big deal, because there aren't many areas of the law here that restrict a person's freedom in this way and I guess if you haven't really thought about it in much detail, it's quite confronting to see how this arrangement takes place with some of the less-cooperative patients. Mind you, most of these patients are floridly psychotic and have very little insight about what's going on. But a couple of the patients we saw were presenting with first episodes of pscyhosis so the signs were very subtle, and would probably not be given any consideration in a different setting, e.g. laughing or smiling inappropriately during the interview. It's hard to put these signs forward to a patient that there might be something not quite right going on. Understandably, these patients denied having any abnormality, but were lucid and somewhat insightful enough to be upset by an involuntary schedule.

Despite all the prep-talks we were given about not getting emotionally-involved or upset by the stories around us, it's really hard not to feel anything, especially with the younger patients who are brought in with first episode psychoses. As my supervisor said, "the worst part is the process of going crazy.. once you're there, you don't have enough insight to realise what's going on". It's quite sad, I think.

Everything aside, the experience has been very eye-opening and fulfilling. Hoping to share more thoughts with you later..

My clinical year ahead...

2010-01-23T20:36:00.011+11:00

Happy belated New Year to everyone! Haven't got any resolutions for this year - I just want some peace and quiet (haha I sound like Oscar the Grouch!)...

So, as everyone who has been through med school is aware, I finally start my clinical placements this year! Woot! My placements will be in a variety of settings but my home base where the majority of my rotations will take place is a busy secondary hospital in one of Sydney's (many!) multicultural communities. It was my first preference hospital, as I come from a similar part of the world as the predominant ethnic group in that community (and speak the same language --> no need for an interpreter!). The other settings that I'll be working in is a specialist children's hospital for paediatrics; a mental health institute and a psych ward in a tertiary hospital for psychiatry; the same tertiary hospital for orthopedic surgery; and a medical centre in an affluent area of Sydney for my GP placement. We got sent our rosters and groups last week - I will be working with two very lovely guys, one of whom I am good friends with, the other I don't know all that well but he sent me an email when he found out that we were in the same group, saying that he was looking forward to working with me this year. As for placements, my roster is as follows (each rotation is 5 weeks long):

- Psychiatry
- Surgery 1
- General Practice
- Medicine 1
- O&G
- Surgery 2
- Paediatrics
- Medicine 2

So, I'm starting with Psych... This is one of the rotations I'm looking forward to, even though I haven't really considered it, as a career. I borrowed two books from the library yesterday to try and start answering questions for the psych short-cases that we will go through on our back-to-base theory days (which will be every Monday). I borrowed Psychiatry At a Glance as I am a big fan of the At a Glance series, particularly Medicine At a Glance and Medical Pharmacology At a Glance; and also borrowed General Practice Psychiatry, which is our core textbook for the rotation but I don't plan on purchasing it as it is quite expensive (> $100) and there are about five copies in the library (plus a couple of copies in our clinical school library).

Apart from doing some readings for Pysch before I start uni (on Friday!), I'm going to spend what's left of my holidays just relaxing, catching up with people and cleaning my room. I have work tomorrow and on Tuesday (public holiday = double pay!); I've got a Dentist's appointment on Monday to get braces because I am vain and don't like my crooked teeth; I'm finally going to go watch Avatar on Wednesday, at the Imax, with one of my best friends who has returned from overseas; and yeah, just get ready to do it all again.

Before I get going, it's been one year since I started this blog! I know it's not exciting, but I started it to vent about life and the world around me at a time when it felt like no one was listening. Things are a bit different now, but I won't forget the favour that you have done for me dear readers, you who have read and listened - thank you!

Post Script. I've decided to change my blog name to Miss Purple Stethoscope, because:
a) My name isn't really Sascha Fierce (my first name isn't even Sascha :-/), I just chose it as a random name for my blog because I'd watched an episode of Oprah the day before starting my blog and Beyonce was talking about her new album I am... Sasha Fierce and I thought it sounded cool and trendy and would therefore make my blog (and me) look/sound cool and trendy.
b) I love my purple stethoscope, it goes with all my clinical/hospital clothes! and
c) A new year should bring exciting new changes with it, like a new name, for example :-D

2009 : A Series of Unfortunate Events - The Ending...

2010-01-22T20:53:00.006+11:00

You're not going to believe this, but I will tell you what happened anyway. I was *so* looking forward to today - the day of my final exam for 2nd year Med, the day I can finally put the dramas of 2009 behind me and finally start my 2010 like everyone else has. I had grand plans for the upcoming week to make up for my missed holiday time. I'm not asking for much, I've come to appreciate the small things that are easy to take for granted - some peace of mind, wellness in health for myself and those around me, a bit of free head space to enjoy life without worry. I really just want a week of mental rejuvination before going at it again. But alas, life has happened again when I have least expected it.

This afternoon my dad got hit by a truck as he was crossing the street to return to work from his lunch break. He is alive and well. But OH MY GOD imagine the shock of my life when I turned on my mobile phone after finishing my exam, to get that dreaded phone call from St Vincent's Hospital. Oh my dear dear God.

Tonight is my last night of 2009, as far as my warped schedule is concerned. Tonight I will give it to them, to do what they like to me and my family in my final hours of 2009. I refuse to start my 2010 this way, so tonight I give you my final vent for my 2009. Stay tuned tomorrow for my 2010 agenda...

Catching up

2010-01-18T20:31:00.005+11:00

This week, I sit my deferred exams. One on Wednesday, one on Friday. I'm scared. I don't want to fail. Presently, I have no other skills or useful qualifications that I can fall back on and I don't have it in me to repeat 2nd year. Okay, need to make myself feel better. If I fail, I am going to leave this God-forsaken degree and either:

1. Do a Masters of International Public Health and dedicate my time advocating for the implementation of public health programs that will save many more lives than I would have as a doctor anyway;

2. Do a BTeach and become a science teacher (children are the future, teach them well, watch them grow, blah, blah..); or

3. Become a pastry chef apprentice and eventually open up a cafe/bakery/cupcakery.

Feeling a bit better.

Lately...

2009-12-24T14:51:00.006+11:00

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!

More on life and its ironies

2009-10-25T23:03:00.007+11:00

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

Above everything, I am...

2009-10-12T22:50:00.003+11:00

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.

Life happens when you least expect it

2009-09-28T00:48:00.007+10:00

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!

Irked

2009-09-09T16:33:00.007+10:00

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.

The Greener Grass

2009-08-24T01:23:00.005+10:00

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 :-)

10, 9, 8....

2009-08-03T02:28:00.000+10:00

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

Control

2009-07-31T00:56:00.003+10:00

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

Much ado about nothing

2009-07-21T22:05:00.002+10:00

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 blasé 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'être (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!

The five people you trust the most from med school

2009-07-17T01:06:00.006+10:00

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...

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

2009-07-14T00:21:00.008+10:00

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).

Of blood, brains and glory!

2009-07-12T11:05:00.008+10:00

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!

Sometimes, I really hate change

2009-07-08T01:36:00.007+10:00

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"

Review: Doctor's Diaries

2009-07-07T00:15:00.009+10:00

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!!).

Crazy - Confronting - Considerate

2009-07-04T01:11:00.005+10:00

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.

Stranded

2009-06-30T20:56:00.002+10:00

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)/

Back...

2009-06-28T06:39:00.007+10:00

...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!

Mudgee, Day 12 - One Last Drink

2009-06-26T21:14:00.001+10:00

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.

Mudgee, Day 11 - Happy Bowel Day

2009-06-25T22:16:00.000+10:00

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?

Mudgee, Day 10 - Flying solo in Cas

2009-06-24T23:42:00.004+10:00

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.

Mudgee, Day 9 - Diversity

2009-06-23T18:12:00.006+10:00

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.

Mudgee, Day 8 - A Dose of Anaesthetics

2009-06-22T23:14:00.000+10:00

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?

Mudgee, Days 6 & 7 - Weekend Road-Trip

2009-06-21T23:38:00.008+10:00

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!*.

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

2009-06-19T23:32:00.013+10:00

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...

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

2009-06-18T21:58:00.010+10:00

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?

Mudgee, Day 3 - Venepuncture Heaven

2009-06-17T18:24:00.005+10:00

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...

Mudgee, Day 2 - Theatre Day

2009-06-16T22:15:00.008+10:00

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

Mudgee, Day 1 - Welcome to Mudgee

2009-06-15T19:41:00.017+10:00

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:

P!nk

2009-06-11T01:46:00.009+10:00

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

So much to do, so little time

2009-06-10T02:51:00.013+10:00

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!)

Nobody knows

2009-06-09T23:39:00.002+10:00

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.

What would you do?

2009-06-08T20:04:00.006+10:00

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?

Well, that's just annoying...

2009-06-08T18:28:00.004+10:00

I was trying to clean up my blog and delete unpublished posts when I accidently deleted ALL my posts. Aw :-( Does anyone know how to retrieve lost posts? Grrr... this must be some sort of punishment I'm getting for procrastinating rather than studying for my mid-yearly exam tomorrow. Le sigh!