Dear FMH,

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

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

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

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...

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...

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

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.