summer holidays and electives

so its been 3 weeks since my exams ended and I've since returned to Singapore. started my holidays with some wisdom teeth extractions, and that put me out of action for almost 10 days. Things have since settled and life has gotten back to normal. The weather in Singapore has been surprisingly good, relatively little rain so far and it hasn't been as hot as expected. The weather tonight is at 23 deg C, which is rare but also aided by the rain which lasted the whole day. Golf has been going ok, but not as well as I want it to be.Some new modifications to my driver, but my swing still requires some tweaking.

Currently doing an Elective in ENT at Changi General Hospital, and its been wonderful so far. The doctors have all been really nice, from the consultants to the MOs. only my 3rd day into the placement and with 4.5 weeks left, Ive learnt so much apart from the clinical medicine aspect of it. The spectrum of dieases, the patient mindset, career advancement and prospects in surgery that I've come to be aware of has opened my perspective of medicine to a whole new level. Also, from speaking with the team of doctors, I've somewhat had a paradigm shift in terms of my plans following graduation from med school, and my myopic outlook of a surgical career has been cleared up quite a bit from simple conversations with the various ENT doctors. Thats not to say I've been discouraged or anything. The challenges are tougher, but my motivation has never been greater.

More to come in the next month or so. I'm really glad i started on this elective.

short of breath....

strange thing happened today, wouldn't expect it to happen, even more so with the hard work that I've put in. as usual, with most exams, I get trouble falling asleep the night before. But last night, it was quite a shock. Each time i closed my eyes, al I could feel was my heart racing, and no matter what I tried to think about or NOT think about, it wouldn't go away. What was worst, was that on 2 occasions, I actually felt short of breath and had to sit up in my bed to catch my breath before trying to go back to sleep again. I don't know how I got through today, must have been running on adrenaline or something.

I think i've been putting too much pressure on myself, pressure to be the best and pressure to not disappoint myself and it sort of backfired. Even more so, when I won a prize from the Faculty; I felt good at first, but then I felt I had to perform even better. it's only one more exam before the summer holidays start. Can't wait, this year has been too long.

surgery and frustration...

so today i decided to go up to theatre to observe some procedures by my tutor Mr Saunder after a long long hiatus from the OT. Varicose veins and stripping them away was on the menu for today. Not a complicated procedure at all, but watching it for the first time; it appeared quite brutal. Sticking the stripper into the veins after tying off the tributaries, making an incision on the opposite side, and pulling the stripper through, and what you have is the vein pulled out, inside out. avulsion of the varicose veins is what they call it. as the stripper is pulled through, you can actually see the veins underneath the skin tugging on the skin, bunching them up together, then with the intermittend breaks and snaps, the vein is slowly advanced out in jerky steps. and alter seeing it the second time, I thought to myself,' I could do this, dosent seem so difficult at all." see one, do one, teach one. but that would be so many more years from now.

the incident that took place after that was quite surprising to me. once again my tutor's cases was bumped off the list and he was made to wait well into the evening. I could read from his facial expression and body language that he was really pissed off at that happening so many times and had lamented the fact that because of his cooperation on most of the occasions he was being bullied. This let me to think, 'how is it possible that someone of his professional stature; with multiple administrative appointments remain calm and so in control of himself. Had I been in his position, i would have pulled rank, and used my authority to demand things happen for me and not consider the other cases on the list. I would have offended so many people and made myself one of the most hated doctors around. I guess sometimes its better to realize that letting such things get to you not only does not help the situation, it might also affect the surgeon's performance on his patients that day. The next time i find myself in a similar situation, i'll think back to this day.....

consultation...

so today i decided to skip occupational health tutorials and sit in on the Neurosurgery clinic. This time of the year for me is Neuro Hx and Ex practice, and today musta been the best opportunity thus far. Not just sitting in, I was given a room to see patients on my own and then later confer with the registrars/consultants with my notes, to get them signed off. This afternoon would definitely be the first time i actually felt like I was a doctor.

sitting there one-on-one with the patient, in a consulting room. some of these patients had waited a couple of hours, but still they were happy to let a lowly medical student like myself assess them. Being post-operative follow ups, they weren't complicated or anything, neither did I have to diagnose them, but it was such good practice to do my examinations and histories and note subtle differences due to neuro-muscular involvement.

When I was asked to do a 1 on 1 consultation at the start of the year during the Vascular clinic, I was very very apprehensive and even scared. I did that with a final year student. But today it was different, felt like nothing could stand in my way, and was feeling really confident about my won knowledge and clinical skills. its also very interesting to note that several instances during the consultation, somehow despite my early mentioning of my medical student status, I was still asked questoins about prognosis; how and when they could return to normal activity. one patient even mentioned," i'm afraid to have sex, im afraid that if i go too hard at it, my neck will play up." and my response was," errr....ok.." and then later on, the patient did not mention this to the doctor, as easily as she said it to me.

thebreak i took 2 weeks ago has served me well. the studying is better, concentration better, and retaining and retrieving information has been good too. I hope to carry on this positive attitude and confidence as long as I can in medical school and as far as I can into my career, and making it better. each step of the way.

recovery....

so the weekend is here, and im just chilling out. the past week once again was quite hectic and after each day i never felt more tired than before. Even my friends were asking me why I am looking so tired. so i spoke to Dr Ip and asked him for advice, on this mild burnout. Well according to him, people like me do not take enough breaks, and that's true. I feel guilty when i take breaks. and it is so hard to take a break and risk losing the momentum, especially in medical school where the knowledge needs to be at our finger tips everyday. But this weekend, i will take Dr Ip's advice and doing everything else but medicine. bought myself 2 books to kick back with, a 6 pack of pure blonde and some good ol' deli chip. recovery is the priority now......

lethargy...

the last few weeks have somehow been exceptionally tiring. I would reach back home after each day and feel incredibly exhausted. and come the weekend, all i seek is to spend a quiet time recuperating. my social life is at an all time low, I haven't been out partying or meeting people in the last 6 weeks.

On the top side, I've been on top of my game each day in the hospital. Pwning others in bedside tutorials and answering most questions from consultants correctly during the clinics. Something in this formula seems to be going right at this point; while it's not the best balance as noted from my insignificant social life, I feel my knowledge and competence as a medical student has developed quite tremendously and each day i feel more confident about my own abilities. rheumatology has been one field of Medicine that I have been able to keep my interest in (also cos i've been quite good at it), other aspects of medicine have just been plain boring, the only other exception being Gastroenterology. Neurology is coming up soon, so hope that goes well. i just hope I can keep the faith and continue til the end of the year without burning out.

Two books I've read recently, "gifted hands" by Ben Carson and "Hot lights, Cold steel" by Michael Collins. both stories about the life and experiences of surgical training, which have been discouraging yet at the same time truly inspiring. It's amazing how these doctors can achieve so much. Being in medical school seems like such a huge task already but yet they've far exceeded their own expectations. I hope to be like that one day, even if it means 90% work and 10% play.

080808

so today the date reads 080808, which in chinese tradition/beliefs would be perhaps one of the most auspicious days in history of mankind. chinesekind that is. today is also the opening day of the 2008 Summer Olympic Games, in Beijing China. Much controversy have covered the lead up to the games, but it seems like it's turning out fine. you can always trust the chinese to be well coordinated, efficient and impressive. Although I personally have an agenda against the mainland chinese because of their general uncivilized behaviour and uncouth like nature, i hope they pull off a good one, and not embarass the rest of the chinese looking people around the world, who may be subjected to a case of mistaken identity.

and i saw this on fb today.....

vexed....

today the australian tradition of inefficiency was taken to a new level. inefficiency might not be the best word to describe this particular event. Waiting eagerly for my results to come in the mail, I was starting to feel something was amiss, when my results failed to show up like all my peers. But also having been away for the past month, I decided to look thru the stack of mail, that had the slim chance of concealing the envelope I so eagerly seek.

Did I find a letter from Monash University? I sure did.

Did the letter contain my results from last semester? NO!

What the letter did say instead, was that the FACULTY of MEDICINE was " your attendace at the year 3 formative exam was recorded as ABSENT" " It is disappointing that I FAILED to take the OPPORTUNITY to EXPERIENCE the format of 3rd year examinations" which were substantially different from previous years of study. The faculty also sought from my part "an explanation for my absence from such an important learning opportunity"

So I called them up and asked them what the fuck was going on. and it appeared just like in a David Blaine magic show, my script turns up in the pile of 'empty' scripts, the extras that weren't filled in, hence MISPLACED. I seriously don't expect such mistakes to take place in an institution of that like Monash, one of the BIGGEST and highest ranked universities in Australia, plus I don't pay FULL FEES for this to happen to me. Now, I have to wait again for my script to be marked and for the feedback and remarks to get back to me......

the medical interview.....

so i've just finished reading this book " the soul of doctors". its a collection of personal experiences by medical students from Harvard Medical School. and it touches quite close to home the personal experiences I have since starting clinical rotations. one particular story that struck me the most was that of the medical student being turned down repeatedly by patients to take histories or perform examinations. He hated those patients and even more so their ignorance on their contributions to the teaching of future doctors. Not that I haven't been turned down before.

I've been turned away as many times before as the next medical student, but today seemed oddly different.While I use to bear quite a grudge on the patients that were unfriendly and stubborn somehow things were different today. Having set myself the task of seeing 3 patients a day this semester, I decided to start my day at the Gastroenterology ward today, to brush up on my GI Hx and Ex skills. Patient number 1 " sorry, it's embarrassing enough, my story, I dont really want to share it with students" Patient number 2 " I'm having trouble breathing right now, I'm sorry". I don't mind such patients who tell you from the start they did not like to be disturbed, the worst ones are the ones who agree at first and then decide halfway through to get pissed off and tell you to leave, those people are a huge waste of time, not just mine but the hospital's as well. But noot feeling defeated, I press on and I find 'david', chronic alcoholic who was at first apprehensive but warmed up and shared with me his life story. then came Mr R who was so obliging, you wish all patients were just like him. and last of the day was 'Mano' another wisened old man who was a great story teller. Because of his gregariousness, his history was a tough one to take as he often went off track. These 3 gentlemen restored my faith in the existence of the 'good' patient.

Alot of patient's really aren't aware of the amount of influence they have on a medical students development and their learning process. Every single patient, complicated or simple adds great depth to a future doctor's medical acumen. while i can understand their concerns for wanting their own privacy, there is really no other way for good students to become great doctors, without learning from the sick themselves. To all medical students out there, and those deciding to enter medical school, like everything else that you seek, good things don't come easy and persistence always pays off.

good bye 15May - Vua Hac Vua Lac

today we had the English championship, the culmination of events in the past 2 weeks, to give the children a day of fun-filled activities involving games to reinforce the english they've been learning from us.

i woke up today with mixed feelings, and they persisted to occupy my thoughts throughout the day. We spent the morning preparing the school, hanging up banners, decorations, preparing the game stations as well as putting together goodies bags. At noon, it looked like it was going to rain heavily, threatening the days activities, but then the clouds held up and GOD gave the children a day to remember. I truly believe this was gods grace, he definitely didn't want the children to have a day of disappointment. The activities were scheduled to start at 1pm, but then at 130pm, only a handful of children turned up. This was somewhat depressing at first for us, and even more for the members of the EC component who faced so many setbacks and obstacles from day one of PV08. Thankfully, the rest of the kids turned up at 2pm, and the days planned activities went on as planned.

My mixed feelings were stirred mostly by 2 antagonistic views. Firstly, seeing the smile on faces of the children throughout the last 2 weeks and even more so today; I've never really felt happier and more satisfied with anything I've done previously compared to my time spent here with SEALNet. The second feeling is one of sadness; I feel really sad to say goodbye to them. I wonder how much we've done in the last 2 weeks will really affect them. Coming into this project, I knew that we could only do so much for them, but I truly truly hope that in 5 years time, If I get the opportunity to come back and see these kids grown up, they would have somehow with God's grace and blessings made good with their lives and continue to pursue excellence. What is worst is that I can't speak Vietnamese, so it was really hard to say goodbye to them. It was only in the last few days where these kids actually started addressing me by 'Jeremy', before it was just facial recognition.

Well, there is only so much that can be achieved in 2 weeks. I just pray and hope that these children will have good lives. I know they won't be reading these, but I want to say this to them, " I will truly miss everyone of you, (Thuy and Dao especially), you have changed my life and my perception of life. You have provided me a life lessons that I would treasure for the rest of my life and I can only wish that I have at least left some figment of an influence on you." " I will always be thinking of you and praying for you, but come next week we won't be around and I pray you won't be sad, continue to be a kid and at the same time be good."

PV08 Day 9

today, the last event for the leadership component came to a close. the mentees, divided into 3 groups were tasked to come up with 3 different community service project proposals to benefit 15MAY School once SEALNet concludes its project here for 2008. I must say, and I believe I speak for most of the team, that we were all very very impressed by their presentations. they were all of exquisite quality and also very feasible and practical.

The presentations all displayed organization, good team work and also quite impressive public speaking. I personally feel a sense of satisfaction with the fact that we saw these mentees incorporate the skills obtained from our workshop and applying them so well, it exceeded my expectations; despite them being Vietnam's brightest bunch. Shang and myself were most impressed with the group which we supervised today (Picture-Dictionary group). They took our critique and tips, and improved their final presentations so impressively. In addition, the feedback we got from them about our series of workshops was generally positive, with some very very encouraging remarks.

During the past week, there were many occasions where we as mentors had doubts about the commitment of the mentees towards working with MAY15 School once we leave, due to the fact that a number of them raised the issue of being able to relate to these 'street' children. That being said, I believe we have a new found confidence in their abilities and willingness to continue the work we've done and bring it to greater heights.

On a lighter note, my good friend, Shangster annd myself have progrssed from 'Sao Zais' to 'Tep Zais', that is from ugly boys to handsome boys according to Dao and Thuy, the 2 cutest girls at the school.

I can't help but think how they would feel monday, when SEALNet no longer shows up to their school.............

Project Vietnam Day 8

today has been quite a good one. Most activities went along smoothly and everyone was in high spirits, despite yesterday's emotional sequence. Because most of the leadership workshops have now concluded, i decided to help out with the english curriculum and got involved in some teaching. So this afternoon I helped out three little girls with their English, aged between 7 and 9. I find it very amazing that despite the language barrier, teaching another language to a child has not been as difficult as I anticipated. Given that more effort and time has to be put into the child during the interaction; the process taking place in the class room has been a very enriching and self-discovering experience. I never once expected I would be able to sit so patiently for 1.5 hours with a child, and more amazingly actually having them behave themselves. The interest in the subject and the enthusiasm for learning is truly AWESOME; even more so for children with such unfortunate backgrounds.




In the last 8 days, not only has the team worked against challenging odds to reach our goals, we have in the process also developed our own independent project which we hope to see become a reality. On the cards currently include:

1. Long-term Donation for Binh Loi shelter and Can Gio shelter, by means of an online system; which will also serve to sustain and develop the work that PV08 has done

2. Engaging NGOs to increase their awareness of such needs in some areas/communities of HCM.

3. Increase awareness of the work by PV08, by means of a project blog and possible website.

I really hope to see the fruits of our labour go a long long way, whether it last 1 month or 1 year or even 10 years, the impact this project has left on us individually, the children, and the mentees will be a milestone in all our lives.

PV08 Day 6 + 7.

Day 6

The past 2 days have been rather intense in terms of work schedule. full days of workshops to conduct + a very early morning start to Can Gio, to visit a rural shelter. Alot has happened in the last 2 days and several emotions have been stirred. this is where i shall start my blog entry tonight.

several emotions were stirred a few days ago during our nightly debrief sessions. some group members felt somewhat inadequate in terms of their value towards this service project, while the leaders of the project felt that the project was coming apart as some members of the team helpless; and they could not provide direction.they even cried. Sometimes, I feel that when people take on responsibilities and tasks, they tend to stray from it. I don't necessarily mean this in a bad way, i.e. shirking off responsibilities. What I am trying to say is, we often set lofty goals and these goals may be far beyond our own capabilities. When these tasks aren't accomplished to our expectations, the feeling of dejection and failure becomes a greater insult. This however, does not give us an excuse to settle for mediocrity or 'average'. This is one of the main lessons that I have taken away from my experience with SEALnet so far.

Visiting Can Gio today was quite an eye-opening experience. Seeing the state of living in the community there was quite surreal. Given the 3rd world status of Vietnam, one can still find it hard to believe that there are still places around with living conditions so poor, one would classify them below rudimentary. I could not imagine myself growing up as a kid in such a place, and I thank god for blessing me with such a fortunate life thus far. We spent most of the time playing children games with them, some might find them really silly, but just seeing the kids enjoy themselves made it all worthwhile. We even took them out to the beach for a few hours of fun, if we weren't there they would not have other means of going out of the compound for fun0filled activities.

Tonight's dinner has been the most fascinating to date. I actually tried some half-hatched duck eggs, steamed to cook. It actually dosent taste that bad, pretty much like a mild salted duck egg, or a century egg. but then I was curious and decided to perform an autopsy with my innate surgical skills, with the rest of the table like an audience of eager medical students.

Day 7

During our time here, we also have several 'professional' mentors. Their alleged role is to provide MENTORSHiP and guidance for us the PV08 team members. But so far, all they have done is actually nothing more than create more unnecessary emotional tension. I know they have no intention of doing so, neither do they wish to compromise the dynamics of our team. But perhaps, they could have been more astute in their judgments which would have avoided some hurtful comments thrown out in the spur of the moment. Not only did this meeting not serve and positive benefits, it was very frustrating, and no doubt left a dent in our framework. But these have now been resolved, and there are more important things at hand to address. The mentees have started to rebel against us the mentors and we find it an increasing challenge to balance between accommodating their needs without compromising their learning experience.

On a lighter note. I must comment on the varying standards of Vietnamese cuisine i have been experiencing. The Pho restaurants have been great, and so are some of the swankier restaurants. that being said, we have also experienced restaurants which got our orders wrong several times, took ages to deliver our orders and last but not least the BADDEST tasting chicken rice or Can Ga I have ever tasted. The rice was tasteless, the meat cold and the skin LEATHERY. Truly disgusting. In the words of Shang, 'definitely a gustatory insult, that would leaves more to be desired"

SEALNET PV08 - Week 1

On the 30th of June, after a somewhat sleepless night, I boarded SQ178 for my adventure in Ho Chi Minh City, Vietnam. Some people still call this place Saigon, but that is besides the point.

Arriving at the airport, I was received by Thao aka Viola who also happened to be a Medical student where we waited for another PV08 participant Azusa from Japan. After leaving the airport for the Le Duy hotel, the thing that amazed me most was the HCM traffic. motorcycles aplenty, cars, vans and taxis abound, the vehicles weave through the roads and alleyways with complete disregard for traffic 'rules'. Zebra crossings have no significance, as do red lights. With this in mind, if anyone actually observed 'conventional' traffic rules, one might find him/herself in an accident pretty frequently. road lines also seem to be merely a formality, as vehicle traverse the lines carelessly, and I find myself sitting in a vehicle destined for a head-on collision. In addition, motorcycles weave in and out of traffic; mothers with toddlers in arms, ladies with stilettos as well as grandmothers. many a times I have found my life hanging by a thread, whether sitting in a taxi or crossing a road.

Arriving at the hotel, I had a wash up, and decided to 'explore' the surroundings. Knowing that petty crime was frequent, I decided to only venture to a nearby mall.It took me 5 minutes to cross a 2 lane road, which seemed effortless to locals. even on a '1-way' street, I had to look both ways before crossing; while walking on the pedestrian pavement, I had to look out for moving motorcycles; such is the state of HCM traffic. If anyone can cross HCM roads with ease, they would be jaywalking kings anywhere else in the world.

The team so far has been amazing, people from all over the world. Japan, Malaysia, USA, France, Cambodia, Singapore and Vietnam too. It is quite amazing how all of us, stranger to each other, gelled so easily together from day 1. Many of these other group participants from very prestigious institutions yet humble and practical/logical perspectives. Having been assigned to the leadership group, we were in charge of conducting leadership workshops as well as playing mentor to HCM's brightest high school students. These students have been quite impressive. Shy and reserved at first, they have slowly but surely evolved into confident young adults. Their standard of spoken english has also been quite a pleasant surprise.

Seeing the 'street' kids at the May-15 school of HCM and the mentees, it is quite shocking to see such a drastic difference in living standards. On one side of the room you have students with handphones and digital cameras and on the other side, students who have troubled family backgrounds, living conditions so poor, basic clothing and food are even a problem. While some can afford to spend all their time studying, the other group of students go straight to work after school, and work late into the night just to help out their own families. children in singapore are so fortunate. even the least fortunate families have guaranteed education, proper homes and enough food.

The SEAL NET project this year aims to lay the foundation in 3 areas.

1. Creating a basic computing program for students aged 6-11
2. Imparting Leadership knowledge to mentees
3. Creating a sustained interest in English learning.

So far most of the programs have been running quite smoothly, albeit some problems occurring with the english program as well as the computing program. But with this amazing group of people, I am quite certain this project of ours will be a raving success. ranging from 18-24 years of age, the diverse talents and qualities we each bring to the project is invaluable.

50% doctor...

so its now the last week of my first semester in 3rd year of medical school. how time flies. even before even though it seems like its been ages since the first day of clinical placements, 18 weeks has gone by just like that. Turned 23 last week, no dramas there. More importantly after these 18 weeks:

1. importance of breakfast
2. articulating/voicing your knowledge is more important than keeping it in your head and putting it on paper
3. for some people, even after 18 weeks of placement, still remain lazy and unmotivated and I will be having to deal with such people when i actually start working
4. an efficient self-study/revising method should be out there, for the existing one is not working well enough for me
5. unhelpful and unfrenly patients dun deserve my sympathy; especially those who waste my time by acknowledging an interview and then cutting it short halfway --> you people dun deserve the nice frenly doctors, but that is ok, I will still wear a smile in front of you.
6. I need a new study plan for semester 2, to make myself better, to destroy all other students who try to challenge me; especially when I know I'm right.

Anyways, the winter break is nearing and I am very excited about heading back to Singapore to see some friends I have not met in 2 years. Things will be getting crazy from the 15th of June. Can't wait. Even more exciting, my trip to Vietnam to teach English will be an experience that is second to none, it being my first service project that I actually self-volunteered to participate in.

until next time.....

oh check this out...

theatre time....

so today I scrubbed in on a procedure, quite a minor one, but nonetheless supercool. cute little 2 year old boy must have been mischievous, coz he fell face first into the ground and suffered a lacerated tongue. the laceration must have been around 3.5 cm long, jagged edged and quite gory I must say. quite lucky I have a friend who is a Max-Facs surgeon in training, and he allowed me to put in half the stitches to put the little rasclas tongue back together. its really amazing how some simple suturing in some ways is "reconstructive", especially in this little boy, his tongue. Tongue = Speech + Taste + Appearance.

and my multi-purpose reflex hammer arrived today, so its been a good day.

waking up late...

waking up late to the realization that you are late for bedside tutorial is no joke. Furthermore, having only 4 hours sleep the night before only makes matters worst. But most importantly, I skipped my breakfast today, brisk walked to the hospital and rushed up 4 flights of stairs....so i found my group and we shortly went to see a patient.

it was diabetic patient and as we went on, we came to the issue of neuropathy and how proprioception and vibration sensations are affected first before temp/fine touch discrimination.

and at that instant, somehow, my leg went numb, like it freaking disappeared, I couldn't bear my own body weight, and collapsed to the ground. I didn't faint, I just fell. Freaking hypoglycaemic event, compounded by some dehydration overnight.

The importance of breakfast I assure you, cannot be stressed more.

guitar hero

well im definitely no guitar hero. But this game is AWESOME. Haven't played such an addictive game in ages. The songs are awesome and hitting the notes just never felt better. I didnt see the appeal of such games until I tried it for myself, it is a really good social activity, gather a couple of close frens together and battle each other or co-op to try complete the most difficult songs...... Im quite glad I dotn ahve it on my own, otherwise my studies will be taking a back seat. many many awesome songs on this game. I've also been watching these videos of insane guitar hero players who seem to complete the toughest songs with such ease. Takes alot of commitment I must say, more commitment than a medical student to his studies. IT scares me that peopel can play so well,clearly their lives outside of their Wii or Playstation world are quite limited.

Check this out.

why the fuck are Local university students so poor??

so I'm now in the midst of my easter break and I have done zilch for study, but that's alright I need all th motivation I can get and hit it hard when uni starts again next week. The parents are in town to visit, and I've been palying tour guide most of the time. Took a drive up to Mt Dandenong on Saturday morning which was pretty pleasant, had a taste of the famous pies they made at Pies In The Sky which was quite good, but didnt get to try the scones from miss marples. Other than that, its been golfing and more golfing. Holidays = GOlf, what more could I ask for, and we're going again tomorrow. The Irons are working really well for me these days, but im still having trouble with the incurable slice that has been a huge impediment to my game.

Interesting news I came across in the local paper today. " STudents' SeX For CASH" now that totally caught my eye. Apparently Monash Uni students are turning to prostitution to fund their education. Apparently students are' being forced to work long hours' in addition to their studies to pay basic rent, and the president for the Students' Union has called for an increase in the Youth allowance, eligible youths get, which apparently is well below poverty line. According to this guy," students have to meet lots of expectations and society isnt giving them a chance to meet those expectations, as they have to commit lots of time to work instead of study."

Well, what i have to say about this is FUCK U ALL. First of all, the locals don't have to pay their fees upfront, even if they do, its 20% of what international students have to pay. If they're living from home they have zilch to pay for, if they move out, then it's only rent they pay for. So where the fuck does all their money go to??? someone i know made a huge fuss about being asked to pay 60bucks more to live in a room twice the size of everyone else's. She's 20 and she cant make the decision to pay 60 bucks more, she had to ask her parents. Seriously, if you don't pay your school fees, and you get YOUTH ALLOWANCE, where in THE FUCK IS ALL YOUR MONEY??? Most International Students I know have very few issues when it comes to payments that invovles basic necessities. But it is understandable when they say they can't afford it, because it is true when you are paying 40000 a year compared to everyone else who pays 8000, WE REALLY DONT AHVE MUCH MONEY LEFT, but we never make a huge fuss involving 60 bucks a year, 5 bucks a month, 1.25 dollars a week.

I don't care if your parents are farmers or doctors or janitors, prioritize your own fucking money, spend less on booze, shoes and clothes, girls dont need 20 pairs of shoes and if you're hot it dosen't matter what you wear.

when they say life is unpredictable, they mean it....

today I learnt that this patient I saw on quite a few occasions to take a history, do an examination or sometimes just simply stopping by and having a chat and see how he was improving had died 2 days ago.

On the first day of my INfectious Diseases rotation, he was a very sick looking man who had just come out of a valve repair procedure, as a result of bacterial endocarditis. He was barely able to speak coherently and was vaguely aware of where he was. As the days went my, he got better, starting eating better, was slowly able to walk on his own without any aids and in a week or 2 he was looking well on the road of recovery. I must have gone by to seen him around 5 times, which dosent seem alot, but when you compare that to the average number of times medical students see patients its 5x as many.

so this afternoon, I overheard my ID resident speaking to the nurses about what happened and was pretty shocked to hear the news. It is really quite saddening to see a young man who was planning to turn his life around after the disease go just like that, in a finger snap*. What happened??? A ruptured spleen, from multiple emboli that caused multiple infarcts in the spleen. and simply bled to death internally.

oh well such is life, and he will probably be one of many people i shall be seeing in my career as a doctor but he'll probably be the one I will always remember.

the inverse pyramid....

if its something that I've learnt so far, is that other than the biomedical knowledge they teach you in 1st and 2nd year, interview/history taking skills clearly fall short.

They use to say, be sympathetic, empathize with the patient, ask your open ended questions to get ALL the information. What they didn't say was, when do I stop the open ended questions? when is it ok to interrupt the patient and ask questions that you so desperately seek answers to, so as to get a clear and detailed picture as to the events that precipitated and the presenting complain itself.

As it turns out, empathy for patients dosen't really matter in the end. Get the information you want, and start processing and thinking about what's wrong. However, the patient feels towards you is irrelevant, if they need you to make their life better, they won't hold back information from you no matter how big a prick you appear to be.

Lesson no.1

Start with the open-ended question.
'Hi, can you tell me why you had to come to the hospital?"

Pain? - character of the pain, quantity of pain, radiation of pain + associated symptoms. What made it better, What made it worst?

Think about possible symptoms involved in the presentation, and illicit all risk factors and systems review(prioritize questions) as soon as possible. The patient having High Cholesterol is more important than the fact that he had a hip replacement 15 years ago. What happen before the patient fell thru the roof is more important then the fashion in which he fell or how many bones he had broken.

6 minutes, thats about all the time to take a complete yet focussed history, before taking another 6 minutes to do an examination of the relevant systems.

In the meantime, I'll be busy memorising the 1 million causes of clubbing, the dynamic heart manoeuvres, the signs of severity of AS/MR.

7am CBT this morning, now I'm totally shagged out, with more study to do.

Think 3rd year is slack?? think again...while the intensity is manageable, the volume is surely intimidating.

3 weeks in...

its been 3 weeks into 3rd year, and i must say its been really exhausting. even though the timetable is flexible, somehow I still find myself studying quite a bit, so much to know everyday at the hospital, so much to see and even after as much reading you try to accomplish you still feel pretty darn stupid.....more or less settled in to the routine of self-directed learning and seeing patients to practice physical examination skills. take some effort to pull myself to the hospital every morning I must say...but its all been good so far...

in the meanwhile, ive been watching some inspiring videos...

all settled in.....

bought my bed, a new high back comfy 'Managerial Chair" for the long hours of study I anticipate, a Dust Buster, a nice rug, to keep the dust off my feet and into the room, I love this room. My first 'OWN' room, furnished and put together myself, less the fixed items like the wardrobe......and more unsightly stuff like boxes that will leave eventually.. clinical years at MMC, bring it on....I've been put together with a group of students I've hardly spoken to ever before. maybe one other girl, I've said a total of 15 words in the last 2 years....guess i'll have to make the best of it and CRUSH THIS SHIT!!!!


and by the way I can take on 25 5year old kids all at once.
25

back in Melbourne for 2008

arrived in Melbourne early this morning. perhaps one of the most boring flights i've had so far. There weren't many good movies to watch except for the Heartbreak Kid which was pretty good. " Screw OFF!! I'm just joking...... - Uncle Tito"

Terminal 3 is really quite nice. good shops, restaurants, everything just looking really perfect, would love to see that place again.

Apart from that its been a pretty tiring day, unpacking and arranging my new room. I have since moved out of Richo and am now staying with 2 fellow course-mates. 2 girls that is. It is going to be an interesting year ahead. Adding on to this, formal lessons in lecture theatres and classrooms is at best minimal and a thing of the past. pretty excited to see real patients and real medicine in action. some drama perhaps?? Grey's Anatomy-like hopefully.

now the hunt for the perfect mattress goes on, big enough for 2 but not so big for 1. heh. a year of good nights sleep beckons, but for now i'll have to do with the one in my room, which is keeping me awake, hence this blog entry.