Sunday, January 3, 2016

Doctor 101

Why do you want to be a doctor?
Okay now hold on to that thought, can we please read first and come back to that later?



'I sometimes find, and I am sure you know the feeling, that I simply have too many thoughts and memories crammed into my mind"
*
Do you know why Dumbledore has the Pensieve? Because memory is a funny thing, it is. So that he could look back and think, had something gone wrong, why could that be? What could be done? He also said, in the Philosopher’s Stone that it does not do well to dwell on the past. I beg to dream and differ. I think you always has to remember what you once were (mere junior doctor, wrinkly white coat, eyebags the size of Fuji) But Albus Dumbledore is a great man, and we will do well to heed on his advice. And instead of Pensieve, have it written here, my whole two years of training into a single, fat post so that one day when I'm grey and old I could always has access to this fond memory of mine. 

So, the rotations (in that order) 

Obs & Gynae --> Medical --> Surgical --> Paediatrics --> Orthopaedicc -->  Emergency and Trauma

When I first started in O&G, I remember having the most memorable time, not because I was a fresh graduate who seemed eager and most of the time passionate to proving ‘yes I’m a real doctor now’  – but because I really did enjoy the posting, even since the medical school. I love taking care of expecting mothers and there was just something about bringing babies into this world that made me go ‘aah, this is what I want to do’

It was the requirement that being a first poster in O&G, you have to tag for 3 weeks. (Indeed the shortest weeks!) And I was blessed with a supervisor (from my alma mater, brilliant, the kind that when she talks, you could not help but go: wow – I need to be like her)
And then during the final days, during this Ultrasound course held in our hospital, I was met with a nice surprise: a dear professor from my alma mater to which I boldly told, ‘prof, I’m going to do O&G’ and she answered, with a wide smile: ‘you are always welcome back, dear’ Goosebumps. Atrial flutter for a while. (kidding)

ObsGynae was not for just anyone. Labour suite could be detrimental, to some. I wasnt talking about 'eww, the amnioitic fluid spread all on me' but more to 'is it safe for the mother and baby to be delivered now? is it safe to rupture the membrane now? that kind of thoughts.



'Some people cannot believe in themselves until other people believe in them first'
*

Enter Medical, first medicine-based posting. The very core of this profession. There were just too many patients to attend to, diseases to know by heart, so little time. But I made it to the ward at 6 everyday, without fail. Thinking about it made my eyes swell ‘how did I get so determined?’ the answer: the thirst to prove oneself.

This was where all your knowledge will be put to test. And you learnt that each patient was unique, and that the presentation of diseases you so studying in the text book wasn’t always typical. But the approach to a chief complaint eg fever would always be the same. You started to have your own approach to basic diseases.

There was one person that I need to mention. I remember having clerked this elderly gentleman who was put in the acute cubicle, examined and planned the investigations and management for him. I presented the case to my senior registrar, and she did not interrupt, all the way to the management part. And the way she listened attentively to a mere house officer like me and finally said when I finished ‘yes, yes I agree, you can do this and that for him, but why don’t we take some extra bloods for him? And add this antibiotic as well’ 

Moral of this story:
If you are a house officer: don’t be afraid to start from the base. This is the way to learn
If you are a medical officer: teaching (and inspiring your junior is your responsibility)

One day we were assigned to write an essay entitled ‘why do I want to be a doctor’ by our head of department and without doubt, the first line I wrote was ‘I want to be a doctor because I want to be an obstetrician’. But I never turned in that essay, I mean how could you possibly hand only a line when the task was to write an essay? Procrastination level: pro.

I however, went online that day and bought ‘MRCOG preparation book from Amazon



'Everyone is a stranger until you give them a chance'
*

Surgical. No offence honey, but I’m just not that into you. One of the busiest posting, because of the tds rounds. Imagine all ward works need to be done before the next round. Even though my heart is not in the posting, my mind is. The way I compensated for that was to scrub in as many as possible. In time, I fell in love with assisting in major operations especially laparotomy. But still, when I leave the posting I took all with me, never look back.



‘The secret to a good life, is to bring your A game to everything you do. Even if all you’re doing is taking out the garbage, you do that with excellence’
*

By the time I entered Paediatrics, it was already the second year of being a house officer, thus was given the chance to go for neonatal resuscitation during labour when posted in Neonatology. The thing was, when you got a call for fetal distress at 3 in the morning (while on stand by during night calls, blanket all wrapped around) you run as if your life depended on it. The satisfaction and relief when a baby was born vigorous, with a good Apgar, seeing that little creature trying so hard to survive, and you did that for every day for almost a month, how’s not to fall in love? And then one fine day when you were in charge of the acute patients (at least 5 babies that time) and you were able to remember every single thing about them during the consultant round and made you wonder, was I for real, where did that confidence come from? Later that day, when you were assisting the same consultant doing an echo and she remembered you from that morning and asked ‘come and join us in paeds’ true story. I was budged and flustered by the invitation. Well I guess if you really love something, it showed.


By this time, I started to waver. ObsGynae or Paediatrics? But decided to wait first, after all there were still two postings left...



'Trust, and let go'
*

Orthopaedics. Very technical. Screws, interlocking nail, reductions and all. At first I was like, don’t know, don’t care. What kind of mind set, eh? Then, perhaps it was the silent rule that every medical officer in orthopaedics are ‘easy going, fun, laid back kind of person’ that helped, a lot, for someone like me. Looking back, I did miss the operations. The sound when the drill made it into the cortex, the way the fragments were reduced in perfect alignment and seeing the check xray afterwards!

Then it was time to fill the form for MO placement. *panicked

Finally, the last one…



‘I look at you, and I just love you, and it terrifies me. It terrifies me what I would do for you’
*

Emergency and Trauma department. 
Six months in the posting. Always be on the ready, as you never knew what kind of patients you were going to encounter. Stable? Unstable? Potential cardiac arrest? Anything could happen.

I guess the real thing was the transition from being a house officer to a  medical officer. If you were so used to receive and carry out your MOs orders and  sometimes due to the heavy workload, you had no time to question the management. All you think was, ‘my job is to refer this patient and get them admitted, fast’

Plot twist: the table turned. 

My first case as a MO was acute coronary syndrome. She came with a typical chest pain, had underlying ischemic heart disease although the ECG was sinus rhythm, blood investigations still pending, her chest radiograph did show a rather big heart (cardiomegaly)
I knew it was ACS, unstable angina more precisely but I just could not commit into diagnosing it. Had to consult my specialist only did I feel safe. Kinda funny. Oh, early days as a medical officer surely made  me cringe so much. But to be honest, even though I had been a doctor for 2 years, it still hadnt prepare me when it came to the one who had to made a decision, came up with a diagnosis and management plan. 

And somewhere along this posting, I knew I did not want to pursue in O&G anymore, the idea of getting adrenaline rush everyday at work was even more thrilling. I knew it then, not O&G. It was a clarity, it took me two years to realize that. 

******

Back to 'why do you want to be a doctor'?
My answer: cos it is the only thing that make sense to me, after all I have no other skills beside listening and attending them strangers


Few notes:
1. attitude is the most important, you might not have the knowledge, but it could always be gained (provided you read) 
2. always know your limitation, never be afraid to clarify, remember that we are dealing with lives here
3. find your muse - this is interesting. I have a muse for every postings, they kind of keep me going
4. treat and take care of yourself well
5. if you already know what to do eg medicine, and you go preparing for mrcp, that's even better!


Saturday, July 4, 2015

Yes it's the festive season soon I am well aware of that fact but I can't help but wish tailors could accomodate for customers whos had fashion emergency, yknow? Like my baju kerja is way two sized over and needs to be altered but apparently they have stopped taking new orders...too many excuses I've heard today.

It's hard for me to accept that.

I am currently in my last posting as a House Officer, working in the ED rotation where all kinds of patients and chief complaints floods like a blown up dam. The good thing about Kami Sedia Membantu is that we will attend to your needs without being 'oh sorry, we cannot accept your father as we already reached our limit today. Sure his stroke could wait'

Here's to the job that pays the bills. Peace.

Thursday, February 12, 2015

Parallel worlds.



I think, all these years, my whole existence, only today when I watched the speech that I feel, like for the first time in my life, I hear you. I wanted to tell you that. That I really hear you. The world is indeed a dangerous and scary place and I am not ready to smash out from my comfort zone, yet.

What does it feel like? To witness what - as you put it the raw human sufferings first hand?, and that you get to know the truth behind-not just mere speculations?

Sometimes you see things, horribly terrible events and they kind of stuck with you forever. I don't mean the kind of image like once in Med School where we used to observe autopsies and the smell, oh how they lingers! but only for a short while and after that it goes away.

Your job, my job, we are privileged to step into the intimate moments that even the closest family members sometimes not able to experience. At times it feel like I am invading their privacy. Do you feel that way, too?

So dear Mr HF, would you do me the honor of answering: 'How do you control whether to let those things you've seen, affects you or not?' yeah I know it is cowardly of me (even absurd) to ask it here but hey, bite me.

I may look strong and unfazed by everything but deep inside I am nothing but a marshmallow.


Monday, September 29, 2014

Of Plastic Surgery &the Acute Burn Management

Assisting my medical officer during toilet and suturing of a mixed laceration and abrasion wound over the left eyebrow and deeply contaminated abrasion wound of the left zygoma, I was asked: what do you understand of Plastic surgery?

Without putting the question into much consideration/thought I blurted, 'to preserve one's appearance?'

After a few sentences of how strayed my concept of Plastic was he said, 'in Plastic surgery, we restore as much as the form and function as possible'

*

Two days ago was my last day in the rotation. At approximately 1 in the evening, the Burn unit received a young boy with 'second and third degree burn over right upper and lower limb, the back with TBSA of 21%' as they put it.

After two weeks in the posting, you'd know in paediatrics population, 21% would require fluid resuscitation. Ok.

First and foremost, let's get you wander into his background:

A was fifteen, soon to be sitting for exam on the 13th of October. He was the middle child, his sister was married and he got a younger brother who was mentally challenged. The parents were both working that Friday, as were any other days. The moment I laid my eyes upon him, he was shaking and I could not help but think - poor kid, he did not deserve this. He seemed like a clean cut of good kids.

Let me make it short by saying on that day, only he and his brother were home. At 10.45 am, he was fixing the two of them breakfast. 'Wanted to fry chicken for me and my brother' said he.
As he was frying, he felt giddy (since he had not eaten) and somehow the frying pan slipped, and the oil splashed onto him, right to the limbs and back.

He tore his cloth at once and yelled for help. No adults were home, remember?
His cry was heard by his cousin who lived next door, and the uncle brought him to a government clinic at 11.15am.

Up to this point:
1. Can I just let it out, for the whole 30 minutes nothing was put on his body, no initial burn management?
2. It was boiling oil for gods sake!
3. And I think you wise and lovely fella can imagine what kind of burn he suffered

So at burn unit, after he was cleaned and all - we did the secondary survey - reassess the extend of his wound. Based on the Lund and Browland picture, I estimated 17%. Lesser than the initial number, but still, more than 10%, uhuh.(then my MO came and reassess, and we concluded it was a total of 16% involved)

What to do when you have burn injury?
1. Get help
2. In the mean time, the most important step being, to run the wound area under a running water for at least 20 minutes. RUNNING here was the KEY. Please eradicate from your minds that soy sauce/canned sweetened milk/immersing the wound into a container mixed with salt helped because well they did not.
Oh darling you can make a difference.
3. During transport, cover the wound with wet cloths - kind of like wet saline dressing trust me it would hurt less. 

(of course there was more to the acute management in burn injury, let's just discuss the things you could do, and rather let us do the rest eh?)


If you arrive like this image below, all I could think of is:
1. escharotomy
2. you would need a skin grafting

Take home message;
1. Be a responsible adult. If you have to be somewhere, at least prepare food for your kids first.
2. Water is magic. Like time, it heals.

Oh kid, let me assure you, you are in good hands. Plastic team motto: to restore the form and function, remember? xx
 

Saturday, August 30, 2014

Waiting!

1. This morning bookdepository.com sent me an email saying my books are on their way! yeah you read that right, book (s)! I do realize I am only a quarter through Arundhati Roy's The God of Small Things and Sylvia Plath's The Bell Jar but hey, when a girl needs to shop, she shops.

2. I wonder how many more days do I have to wait? -sighs- The thing is, I want them now, I need to read new material so bad. That leads to;

3. Have you read a book for say, the fourth time and still be as amazed and as surprised as you are like it's the first time you're reading it?

I tell you, feelings are weird man. I still cannot brain Augustus Waters's tragic ending. Augustusssssss Waterssssss. Ha.

Some quotes from The Fault in Our Stars:
the world is not a wish - granting factory
pain demands to be felt

and oooh, I probably nope, most definately favor this one more:
you dont get to choose if you get hurt in this world, but you do have some say in who hurts you
and I could just imagine it Augustus breaking as he muffled through his sobs, 'I lit up like a Christmas tree, Hazel Graze'. I should be remembering something else - like why do they replace feeding J drain losses with Hartman's solution? Or what is the acute regime of daflon? SO ON, SO FORTH.

4. Here's me bowing to John Green. John, you could not have been more right when you say time is a slut and that she screws everyone. ps/when I look back at my previous entry, I couldnt believe I was capable of feeling that way. Silly love. Maybe I like just the idea of love.