many things going through my head...

in the past, I felt that personal things should be kept to oneself, not talked about. no matter how much they troubled you. work, relationships, friends..... im blabbering, but what does it matter, no one reads this blog anyway. its just another outlet for me...

Im seeing someone now. her name is Laura. she's great. I use to dread relationships....boyfriend and girlfriend, losing the freedom you have as a single person....relationship averse....and then I met Laura. you don't miss singlehood when you've met someone you truly cared about. there's so much more to do and see in places you've been before by yourself. It's like travelling alone, I've done that before. Being carefree, being whoever you wanted to be; but then as you travel you realize there is actually alot more you could do and see if you had a travelling buddy, be it a friend or someone special. I use to look forward to weekends, coz it simply meant that I did not have to work. but things got old, and weekends were often wasted just being by myself and not making full use of it to experience things around you....and then I met Laura. I can't wait to see her again even if I just said goodbye that same morning. I can't wait to hear her voice, even when I've just put down the phone...you become someone you don't expect yourself to be, you do things you would not normally do. you put yourself in a position that makes you uncomfortable just so the person you care about is happy...........................


palliative medicine has been quite confronting in all honesty. before I worked here, it seemed to me that the whole concept was the anti-thesis of medicine. In medicine, we help people get better, fight disease...make people better....but palliation was giving up, surrendering to the affliction. It was ok at first, then everyday someone dies......its not the dying that is difficult. They are comfortable and painfree... i hope. we try to achieve that. it is the experience of people coming into hospital, getting admitted.... knowing that they have come to die.......what exactly goes thorough a person's mind when they acknowledge the fact that they were GOING TO DIE. In a medical ward, you might still have the 'reassurance' that doctors will do all it takes to make you better. But in a palliative care ward, there would be no more treatment. There would be no more fight. What exactly goes through a person's mind when they wake up every morning, knowing that the next day is going to be an agonizing wait....and that if they wake up the next day they won't be feeling better, but will be feeling worse.

When a patient of mine's condition seemed to have plateaued and did not look like he was immintely at death's door, we had to find a place for him to go to. A nursing home. he said to me,' so the time has come eh? ' I had no idea how to respond, how do you even respond to something like that.knowing the time is coming, but you just have no idea when that was going to be.....


palliative care is sad. kudos to the wonderful nurses and doctors who choose to work in this field. working in a place where everyone is dying or waiting to die is tough, I have alot to learn.....

disappointed.

today I set myself up for disappointment. thus, this will never happen again.

lost in the cracks

so... early last week whilst I was going about my daily routine trying to finish up with ward work for the morning, I get a call from the radiology registrar. " Hi, I need to see if you still want this CT-scan to go ahead because Mrs XXX's renal function is deteriorating" "Mrs Who??" "Mrs XXX, she was here 3 months ago...." "......er....I have no idea who she is.." " well, ask your registrar, it has her name on the request slip, thanks *click*

me to registrar,' erm, I got a call earlier about some lady needing a Ct-scan, but has deteriorating renal function, do you still want it to happen?" " well, shes got pancreatic cancer, she is 87, she definitely needs someone to be following this up, th escan dosent have to happen urgently, but it needs to happen"

a few phone calls later and another few visits to the radiology registrar, I have yet to make sure this woman's cancer is beign watched. Radiology refuses to schedule a scan until they have evidence that the lady is fit to have it, patients GP is 'part-time' and therefore will not be at the clinic often enough to constantly monitor the renal function and book a repeat scan. Also, patient is NOT IN HOSPITAL.

This situation has bugged me for quite a bit mainly because of individuals refusing to take ownership of a patient who has clearly been seen by them, and NOT ME. Radiology throws at me stupid excuses of rare reactions to contrast if someone's renal function is not up to scratch, GP gives me excuses about the part-time employment. Why can't the stupid radiology registrar just book a date, so that at least some sort of follow-up is in place. Why can't the GP who is in the community just add a reminder to one of her GP programs that is so sophisticated these days?? why am I loking after someone, I have no clue about, let alone not a patient of the HOSPITAL?????

Here I am, in the middle, having to ensure that this lady's cancer is not left to fall through the cracks. She's 87, probably not fit for surgery, and my registrar reckons she might do with radiotherapy?? even non-invasive, it it not without its side effects as we all know.

this is ridiculous. a woman with cancer, and no one seems to care, just because she's not sitting in front of them. I wonder, how many patients are unfortunate enough to fall through the cracks like this woman?? How many individuals have missed out on early diagnosis or intervention, because someone far away decides that a scan needs to be cancelled, and then left up to some one else, in this case me, who has no familiarity whatsoever with this person to make sure things are in order. Am I handling this because it is my responsibility as a doctor with a duty of care to this patient who's notes happen to fall into my lap OR am I handling it because I am a fellow human being?? if so, why are the others shifting responsibility?? am I trying to do the same or convince myself that I am not by putting my thoughts into words to seek clarity...I do not know.

Internship!!

Jan 12th 2011 was the day I commenced my internship. The day of being a doctor had finally arrived, after 5 years of ups and downs in medial school, the day that all us medicos look forward to from day 1 of medical school with excitement as well as trepidation. The first day of the rest of our careers had just started; real responsibilities and real consequences can happen with our actions and omissions.

It's been 2 weeks since I started, but I have only just been able to find time to pen my thoughts down. So I start of 2011 and internship in the town of Mildura, 8 hours northwest of Melbourne by car or a 1 hour flight. Mildura is closer to Adelaide then it is to Melbourne. Twas' a long and quiet drive up, uneventful, but rather enjoyable. This was also during the floods and I was lucky to have driven off from and through Echuca, abotu 1.5 hours before it flooded through. When I was going through, the Campaspe river was already looking to overspill the banks and onto the roads. Thank god!

Internship for me has started with General Medicine and the Mildura Base Hospital. A small and cosy rural hospital sufficient to meet genereal medical and surgical needs. The last 2 weeks has been busy. I did my first cover shift as well as my first weekend. working in medicine has been pretty good so far. lots to learn about medicine, dealing with patients and also equally as importantly, dealing with annoying nursing and pharmacy staff.

Cover shift

Cover shift is worst when yoru fellow colleagues are not organized and do not prepare the paperwork necessary for admitting or discharging patients. sometimes the patients come through, lying there in a bed and none of the medical staff seem to be aware that they are suppose to be there. Also, looking after and making decisions for patients that I had no idea of, from their demographics to their actual medical/surgical condition , this was sickening as it takes up a lot of time going thru the files and charts just to get a vague idea of what is happening and I need to do for the patient. Also, you have the nursing staff and pharmacists hounding you for discharge papers, scripts.............. and there is only 1 of me working.

Hospital Staff

So far, most of the hospital staff that I have met and had dealings with have been very approachable and helpful. The registrars have been great, welcoming us and supporting us in our daily dealings with patients and other staff. The consultants have been more then welcoming in inviting us to the team and making us feel comfortable on the job. However, needless to say there are always the annoying ones who try to pretend to 'advocate for the patient' but in actual fact are hindering the recovery of patients. And then there are the others that try to get you to cover up for their mistakes, re-writing scripts because they have given the wrong dose or sometimes even the wrong medications. They politely ask you to write up medications to help settle patients 'IF they get too agitated in the night' but the medication is more for themselves so they won't have a busy night. stupid irresponsible nursing staff, making us irresponsible just so they can have an easier time.

I was speaking to other friends, fellow interns and seniors who've just completed internship as well as registrars i've worked with before as a student, telling them how frustrating it can get as an intern, where you try your best to make things easier for yourself and everyone else. There is no escaping it. Either way I lose. When I make things easier for nurses, I lose because I become more busy, When I try to make things easier for myself by getting organized and doing tasks in advance, I also lose, because I just get more work to do. Such is the life of the lowly medical intern.

This is my first, and hopefully my last Medical rotation for the rest of my career. I have 8 more weeks of this to get through.

In my 2 weeks of experience, I think the way to make things as easy as it can get for an intern is to be organized and prioritize the work that has been give to you. It takes a while to get use to the way thigns are organized in a new hospital, ward, a new team. But we all get there eventually, and I hope they get easier with time.

where do I belong?

I have just come to realise that being overseas for such a long time, even with the great experiences and memories that you take away, the main downside is that.. you don't make good friends like you do back home, but when you are away for too long, people from home forget that you exist.....

Epic trip - Surgical Elective to Cuenca Ecuador

It has been a while since I last posted an entry. Much has happened since my last dated entry, and this is why i am finally penning down some thoughts about my surgical elective.

On the 27th of August I left Melbourne for my big trip to South America - specifically to Buenos Aries in Argentina and to Ecuador.

Cuenca, Ecuador and the Fundacion Cinterandes. This is where I undertook my surgical elective from the 19th of September to the 30th of October. The foundation started a Mobile Surgical Unit in 1991 and to date, similar programs world wide such as in Honduras and New Zealand. To date, the foundation has performed some 5000+ surgical operations in various rural towns in Ecuador. Procedures range from typical general surgery procedures such as herniorrhafias and superficial tumour excisions to gynaecological, opthalmological and urological procedures. The mobile surgical unit is also capable of performing more complex procedures such as Cholecystectomies both conventional and laparoscopic.

Before elaborating further, I will divide this entry into separate components, 1. Medical/Surgical and 2. Culture and People

Medicine and Surgery

Being able to experience medicine in Ecuador has been a very very rewarding and unforgetable experience. I had the pleasure of being immersed in both rural medicine and surgery during this elective. For 3 weeks of this rotation, I was in at a regional clinic or 'sub-centro' as they call in here in Cumbe, a small town of about 4500 in population, 40mins from Cuenca. Over here, we got to work with doctors, do consults to practice and improve our medical spanish and above all, the opportunity to experience a new culture and their attitudes towards western medicine. Making diagnoses with the aid of convenient radiological exams or laboratory tests are almost impossible here. Much of the management of patients invovles astute clinical acumen i.e. deciding if a patient has infective or parasitic diarrhoea or a viral illness - and whether to send them home with anti-parasitic or anti-biotic agents or allow the illness to run itself out. The arsenal of medications available for any infection include, Penicillin, Ampicillin, Amoxicillin, Metronidazole and Tinidazole. Pain and fever medications available are Paracetamole and Ibuprofen. Salbutamol for any respiratory distress. In order to get these medications for free, patients have to visit a goverment run clinic - medications in Ecuador from a pharmacy are expensive, and for the poor people here, it sometimes can be almost impossible to afford.

The lack of resources here often forces one to come up with new ideas and innovations to help the community - and such a baptism of fire is an invaluable experience. Home-made spacers from used plastic bottles that I saw was perhaps one of the 'innovations' I got to see being given to patients. Even gloves and handwash are hard to come by. Visiting one of the 'big' public hospitals, none of the above resources that I often take for granted in Melbourne can be found. You can't find a single bottle of Avaguard in an entire floor, that normally permeates the hospitals of Melbourne, or even glove boxes. All these things we take for granted due to its abundance in a first world country, are a luxury. Interns and doctors bring their own gloves, masks, scrubs etc.

Being part of the Mobile Surgery Unit with the Fundacion Cinterandes has been the best experience to date. The ability to provide surgical treatment to communities that would otherwise suffer with pain and disability has never ceased to amaze me. Whats is more, the success rates of the surgeries and complications rates are comparable if not better than conventional operating theatres in city hospitals of the developing world.

During these trips, we served as assistants in surgery as well as instrumentors or scrub nurses. Main post-op care was also provided by the medical students under supervision by the surgeons and anaesthetist. Other than the medical and surgical experiences that I gained by participating in this elective, personal reflection has also allowed me to realize how far I have come since starting medical school. The local more junior medical students would look to us in times of doubt, and under the appropriate situations would be able to provide the correct advice confidently and accurately, whether it was general medical/surgical knowledge or details concerning post-operative patient care.

Satisfaction, is an indescribable feeling; the feeling of contentment, joy, being proud of one’s actions but not necessarily with excitement, all put together. People who know me, know of my passion for surgery, head and neck oncology as well as plastic surgery, yet here I was helping out in straightforward procedures, hernia repairs, excision of superficial tumours, cholecystectomies and tubal ligations etc, and yet I was enjoying it. This was not evident to me, until a friend and colleague whom I was relating my experiences to said to me, ‘Jeremy, you have tasted satisfaction’. This trip has changed my perspective of medicine, delivery of health care and perspective of life itself.

Being a doctor is great. Being able to do something to change the trajectory of a human beings medical outcome or life is an amazing skill to have. This has now come to be my personal encouragement to work in medicine. The money, the prestige and respect that comes from the job whether earned or by association are important things in anybody’s personal life, but now I strongly feel that it is the intangible rewards that really keeps me going when the going gets tough.

Vacation time

Travelling alone has opened my eyes to the world. Learning a new language has helped the experience so much I cannot imagine how much less of an experience I would have had, had I not picked up Spanish beforehand. Before this, I use to have the impression that people who lugged backpacks around for trips that seemed to have no end were simply escaping the realities of life, to prolong the inevitable meeting with what they had left behind in the first place.....nothing much to desire.

But now, having met so many different types of people from all over the world, Germany, Austria, Brazil, Argentina, Ecuador, Ireland, South Africa, Korea.. I am incredibly envious of people like that. Taking a long trip is a huge commitment. A commitment to put life, normality, comfort zones on hold while one decides to leave and sometimes be a totally different person for an uncertain amount of time. Could I ever put my life on hold to pursue such experiences? If you asked me this question before my trip, I would not even consider that question worth answering. put my life on hold?!?! What about surgical training? writing papers? research? decorating my CV with all sorts of prizes and accolades?? I was a fool back then.

Now, all I want is to plan for my next trip. Fulfill all the experiences that I want and should have as a young person before stepping onto a train which is my career which has no end station. We are young once, youth will leave us that is for sure, but jobs are always there no matter when you return. That said, is easier said than done. Now having completed medical school, a new 'title' added to my name and another academic degree, we shall see where life takes me.

My trip has also shown me that, there is so much to see around the world, so many cultures to experience, so many different people to meet and so many different lifestyles to appreciate. I want to see the world, I want to live my life, the way I see it fit.

Gynae'oncology...death... and the cancer monster

its 4 weeks into my gynae'oncology rotation and so far it has by far been the best rotation I have yet since starting the clinical years. I have been treated with respected and accorded the duties and responsibilities of a junnior doctor and never made to feel like I was a burden or hindrance in the team. The doctors, Kym the fellow, Annie the Registrar and all the consultants have been very understanding and nice. I could not have asked for a nicer working team. I was going to write about this on friday, but somehow things just got pushed to now, monday 1250am. Anyway, What I wanted to write about was a particular patient (DV) I have helped managed in the last 4 weeks. so last friday she was making those terminal groans and moans that all dying people do, and she was in pain. It was not a comfortable sight at all. And being in that same room with teary eyed family members wasnt an easy thing to deal with. The worst thing of all is knowing how things can change so rapidly. I saw her well and walking (despite her incontinence/fistula) issues, she was still alive so to speak. Now, it would be a miracle to see her still around when i turn up to the hospital tomorrow......I do not really have much to say or rather cant thing of anything else to put down.. but this I will never forget.

End of Gen MED....

I've just finished my Gen Med rotation for 5th year and I must say I enjoyed it much more that I had initially expected.most fortunate enough to have nice and friendly consulant, registrar and resident. perhaps the only downside was to be paired with a moron, who has shit for brains. Taht being said, I have learnt immensely from this rotation. I personally feel that after the rotation, I' have indeed taken a wider step towards becoming a doctor. a much longer stride compared to breast surgery I must say. Writing, referrral, discharge summaries, pathology slips, radiology requests, scripts.. etc are now second nature. Clinical acumen, procedural skills and the like, I think i've made huge improvements in those areas as well. I got to DO so much more in this rotation than in any others from 3rd year,. This is the beauty of being a FINAL year medical student.much experience, and no responsibilities. My registrar feels I have a split temperament, suited for either surgery or medicine. As much as I enjoy the challenge of diagnostic and management dilemmas in Medicine, the lack of decisiveness and certainty makes it hard to bear as a career.

I cant see my self doing medicine, I think its for people with far more patience than I do possess. Patience, thats also one thing I feel I have improved on quiet a bit after having to tolerate the tomfoolery and foolishness of an almost clinically incompetent medical student. One still begs the great mystery," how did he end up passing high school?" much less getting into medicine. People ignorant of their ignorance greatly bother me, especially when I have to be patient and understanding; and allow them to share their opinions. I look forward to Gynae-oncology which is coming up next. Back to the operating theatre, where I feel I belong. the wards are a more cheerful place, but nothing surpasses the focus and decisiveness of a competent surgeon.

I actually am looking forward to be a Gen Med intern next year. But we'll see what happens, this "working" and not getting paid deal is starting to take its toll on me. 2 rotations down, 3 to go before my awesome elective in Ecuador. Cant wait. till then. peace

old and sick

I have come to this conclusion with absolute certainty. I rather be dead than old and sick. It's very sad, for both individual and family, when one is old and sick, lying in a hospital bed with no hope for revovery; the only path is a slow, painful, seemingly unending journey to deaths door. Oxygen masks, endless needles, numerous blood tests to no good end...... the menial things human beings do to hold on to something that is as good as gone. I guess its easy for me to say now, but after having to bear witness to similar sights day in and day out, it just dosent seem like a big deal anymore, when death comes knocking at your door, even the newest technology wont help you breathe no more...

learning curve.....

so in the past 3 weeks i've been taking 3rd year medical students, helping out with some of their clinical skills assessments and giving short tutorials here and there. it wasnt until today that I truly experienced what my previosu tutors must have felt, the frustration that one gets when students (while enthusiastic and eager) do not appear to grasp the importance of certain aspects of the teachings that Im trying to pass on. " Guys, please go home and read up on the following......." in the near future, " guys, can you tell me the following.....". 1st time, you give them soem leeway, 2nd time, you get frustrated, and 3rd time, you start to think that maybe, there was just something in the message that you are trying to put across is not CLEAR enough. its pretty damn frustrating, when 3rd year medical students still behave like they are in pre-clinical years; expecting to be lectured on and doing minimal self-directed learning. The learning curve when one gets to clinical years of medical training is a steep one. I'm very thankful I had someone to direct me when I was in 3rd year. Im jsut trying to do the same for other that come after me, to the best of my ability, and sometimes its just frustrating.

update 1 - needle-stick patient is HCV positive. so now I have to do blood tests for the next 6 months. damn.

unlucky

today I suffered a needle stick injury. the patient has a hx of IVDU and ETOH, and is riddled with tattoos. blood test so far has been good. hopefully nothing bad happens from this. When i got home and decided ot heat up some soup, I forgot to open the lid up enough, and my soup exploded in the microwave. fuck me.

life and death

today I saw a man literally come back to life. whilst the events had taken place over a course of approx 10 days, the progress has been remarkable. an elderly man who suffered a fall and a brain bleed, managed in intensive care and later recovered on the wards. Unfortunately for this man, he then developed blood clots in his lungs which sent him back to intensive care. this was where I first met him and heard of his story. The ICU is a scary place. Machines, tubes, needles, bottles, scurrying of doctors and nurses. Background noises of pumps, machines, patients coughing, choking, gurgling, the list is endless. Here I saw the same man, hooked up to the same instruments and looked after like every other patient with a serious problem. here every patient is broken down into numbers and percentages. the wonders of modern medicine are endless. where a man once laid on the brink of death, where family members had given up home on improvement and signed an advance medical directive. this man is now walking up in the wards, cheerful and talking. if you didnt see him over the course of the week, you could not fathom the strife he was in.

transition camp...2010

so this year I decided to attend Transition camp, which is the orientation camp for 1st year medical students. It's been a while since my own transition camp and I was curious to take a look back in time, to see if I could recognize the changes that have taken place over time, in terms of my own maturity and development as a medical student. The last 2 days have been great. I think it is worthwhile for people to often look back and think about previous milestones in their lives i.e. first day of med school, first day as a medical student, end of first rotation in Final year etc...

confused looks aplenty, shy faces, and anxiety. The look of the fresh medical student on their first days of university learning. Only now that I think about 4 years ago, when I was in a similar position, do I ask myself if I was at that point just as clueless and helpless as these freshies. Certainly didnt feel like it, but most likely that was the case. As was I 4 years go, these new 'kids' have no idea the changes that woudl happen to them as they progress through the years; they might very well know where they will end up, but the journey and experiences ahead still remain a mystery. We as the tutors and guides at the camp impart our previous experiences on to them, hoping words and pearls of wisdom would give them a clearer path in which to navigate from the first day; and in doing-so I personally have reflected much upon my own change in the past 4 years, and also wait in anticipation of whats to come in the next 4 for me.

What's more amazing is the awestruck look, and reverence these first years have when they learn that you (or I in this case) are not a FINAL year medical student. It's like final year medical students have some magical powers to captivate and attract. These very same feelings I had, when meeting final year medical students of yesteryears. While it feels good, it also somehow imposes a greater burden on learning and the continuous pursuit of excellence. The most drastic change I feel is the difference in sense of uncertainty I notice I had, as a result of interacting with these bunch of 1st years in the past compared to now. I'd like to beleive Im quite the self-assured, confident and bold doctor-to-be right now, and no longer the 'unsure medical student'

this has certainly been quite the introspective experience for me. feels like yesterday when I was at this camp myself in 2006. and now, in only a matter of months I will have become a Dr myself, with real responsibilities to society. It scares me, but it excites me even more.

Final year

so I just arrived in Melbourne yesterday and have now finally settled in to my new place. it is spacious, it is gorgeous, it is going to be a fun house. Final year will be a testing year, despite the 'relax' nature of it all, i intend to give it my best when im on the wards, clinics and in theatre. its going to be a taste of what is to come in 2011, and when that time I comes i intend to be fully prepared. 2010 is going to be an awesome year of fun, learning, and out of this world experiences. FINAL YEAR MED STUDENT, ECUADOR, SPANISH, MBBS here I come.

p.s. http://www.facebook.com/album.php?aid=2055511&id=212900539&l=e8e44f7bc9

check the pictures of my new home for 2010.

2010

its been a while since my last blog post, and i attribute this to exams and also laziness, not that anybody is reading. conversations like this in my head happen quite often. I fear medical studies has pushed me towards a psychiatric condition.

jokes aside.

so 2009 has finally come to an end. What a long it was and what a relief that a new year has dawn on us, with so many exciting things waiting to happen. so my 4th year of medical studies have just gone by like that, and I have passed my final exams. unfortuately I did not do as well as I had planned to at the start of 2009. Resisting distractions and practising delayed gratification has not been my strongest suit thus far in 2009.

Being a final year medical student this year, I have mixed feelings about what lies ahead. I am excited about finally being at the top of the Medical student hierachy; where the juniors look upon you with this ardent fervour as I once did to my seniors when I was in 1st and second year. not having any more crucial exams in 2010 has been something all of us have been looking forward to since the day we enrolled in Medicine. My elective to Ecuador in September remains the highlight of my calendar this year. On the flip side, there is the pressure that this will be the final year I get to consolidate all that I have learnt in the past 4 years, to be a competent intern come 2011. On top of this, the pressure to have the knowledge that the junior medical students seek when on the wards; to not be outdone by the very same junior medical students in front of tutors and physicians. Knowing how easy it is for me to get caught-up in busy-ness or lull, I have decided that I will use the time that 5th year promises to provide to study well and be well prepared for the MRCS exam, which I will try and attempt in 2011. hopefully I see this resolution through with a good attitude; afterall i have bought the textbook. Mastering spanish to a competent conversational level is also on the cards as I prepare for my trip to Ecuador.

So now I am actually back in Singapore for the summer holidays and it really feels good to be home. It has been long since I have been able to enjoy the company of family, best friends and above all the comfort of home. I have mostly been going out, clubbing, golfing and playing games on the PS3. In the past 3 weeks, I have met more people here in Singapore than in Australia whom I will actually continue to maintain friendships. This has been something that I have long been missing whilst studying overseas in Melbourne. Being in the company of friends whose company you truly appreciate and enjoy, then the skin-deep, superficial patronage paid to you as a foreigner in a foreign land. having mentioned this, come June/July 2010 I will have to make a very important decision as to where I would be working in 2011. I know for sure, that I will pursue my internship in Australia and let things happen from there on. It would be the smart choice. But there is so much to consider when making decisions like that, job scope, training exposure, opportunities, salary, lifetyle, friends and social life etc...

Much will be happening this year, and there will be much to think about. For this moment, I will just immerse myself in the holiday spirit, focus on what is in front of me and not worry about what is going to happen.

Happy New Year to all, and may 2010 be a better year than the last.

obstetrics and gynaecology - the vagtastic voyage

so 9 weeks of O&G has just gone by in the blink of an eye. The last 9 weeks have definitely been the most memorable experience for me in 4 years of medical school so far. Never before, have I been involved in a more rewarding health care specialty, where each clinic, theatre list or 8hour labour experience was never once a matter of going through the motions. In gynae oncology I experienced HARDCORE surgery, day in and out, on the Labour ward I experienced one of life's natural, most heartwarming experience, the process of childbirth; the smile on the faces of mothers after 8 hours of what seems like unending pain, the tears on faces of fathers after seeing their newborns. In the ante-natal care, the complex mechanisms of physiology, pathology and anatomy made even more challenging by 2 living systems existing in a mutually exclusive, yet interminable bond. I know, its an oxymoron. the experience over the last 9 weeks has seriously made me consider pursuing a career in O&G. Never before have I had something other than Reconstructive surgery exerting such a strong interest. truly, O&G is a specialty for the intellectual ones. The variety of topics one can encounter, from Fertility and IVF, Cancer, Urological issues, child birth, and even Fetal Health requires are all very enticing.
I'm rather glad, that I have had this unique experience which has not opened up my once close mind, in terms of career pursuits. while, I would have liked to maintain my original goals of a surgical career in H&N/reconstructive surgery, i would not have had the experience of searching for the one purpose in life that I can confidently say I would be willign to sacrifice everything else to pursue; which without would have been a great tragedy.

Paediatrics is next, which I am also very excited about. it will be 9 more weeks before the big exams start, which I hope I would do well in. The year has been hard and long. The light is getting brighter at the end of the tunnel.

vaginas and kids

its 0745 hrs now, and im about 10 mins from leaving my house to start this new semester in Womens Health and Paediatrics, another gruelling - if not more intense 18 weeks than the last, before the year is over. I expect exciting times ahead, long hours but nonetheless interesting and motivating. GP and Psych are now put behind me, I didn't have to sit supps, so lets assume I was able to pass and did not fail. It is a good feeling. Not alot happened in the last 2 weeks - yes a mere 2 weeks of a holiday after such a long semester, and its back to the grind, reading books and watching DVDs, musicals and whatnot, a good relaxing period. could have been more exciting. Note to self - plan short holidays in advance in the future. The wimbledon finals was great, just ended a few hours ago. Although my player for this tournament - ANdy Roddick lost out eventually,it was a really really good match. Both players deserved to win, Andy more than Roger. But life is cruel, and I know Andy will be definitely be back with better tennis after this commendable but cruel loss. Better things to come in the future.

GP GP GP GP

so im about 4 weeks into my GP rotation now. boring at times but learning alot somehow. Ive been assignmed to a fantastic GP, a really nice doctor who has been really patient and helpful to me as well as his patients. GPs play a really important role in the lives of people here in Australia, it is quite unlike what goes on back home, where the GP is more like a flu-medication dispensing clinic. Gp placements each week has been good, but the lectures on other days have been quite tiring. Today we had to tell a gentleman the diagnosis of MS. It was actually the firs time I had to see a doctor break bad news to a patient, and it wasnt the most pleasant experience. you could see the guy was outwardly devastated, having a bomb drop like that on a person, can be quite devastating.I cam into GP with some negative impressions about what was going on, just like Psychiatry, but its turning out to be better than expected. I guess i should stop letting first impressions or experiences of others to affect my perception. 5 more weeks to end of the semester, I gotta start working and do well and get these 2 subjects out of the way. Settled my elective for next year, ECUADOR HERE I COME!!!!!

regularity and containment

so its been a while since my last entry, not that it matters since no one is reading this anyway. So psychiatry has been alright. started out quite alright actually, but then we had a 5000 word case report to write up, so 2weeks of the rotation was basically spent preparing and writing it. totally sucked the life out of experiencing psychiatry to its fullest. Imust add that the program hasnt had the best structure, and till this day, I am not sure what I've actually learnt. The doctors have definitely been great though. CATT, CL, block P, CAHMS; I've definitely picked up a few things from the frenlyl regs and residents.now is just a matter of me passing the exams. Anyhow, I was lucky enough to get to sit in with a family therapy session today. It is really interesting to see the dynamics that go on within a family. Even more so when the parents are capable, successful individuals, in this case, doctor and dentist. People also debate about nuture vs nature and how much each actually contributes to WHO WE ARE. This debate will never end, and we will never have a winner. it takes two hands to clap, and what one notices as an outsider really stirs curiostiy into what actually makes a GOOD family, and is there a perfect one? TOday - from the parents point of view, it seemed that they fail to accept the fact that their son being sick today, has nothing to do with their parental ways or their own personality, attributing most of the blame to their son and his intrinsic self. That might be true, but it seems the parents were forgetting that their son's intrinsic self was essentially passed down thru mendelian genetics, and that the family environemnt created by them as parents, and other social influences ultimately has lead to the patient ending up this way. Having said that, the son on the other hand was perhaps more resistant then any child I would imagine to be with regard to parental opinions. Notwithstanding the fact that he is in his teenage years and probalby has much going on shaping his perspectives and his sense of SELF; the amoutn of resistance he was putting up, was FAR greater than even what I would personally do to my parents. Even if my explicit self was defiant and aloof, there was still my conscience that took into consideration what others said; but this wasnt apparent in the kid in question. I was sensing some kind of a self-centred, narcissitic trait.

Its really interesting, and I guess no other profession really allows you to use the experiences of others to reflect on yourself, on yoru own behaviours, thoughts and emotions. It is quite a blessing to be part of the family of medicine.

also, ive just started with spanish classes. been really fun, and really hope to be fluent in spanish by next year. hasta la vista!

byebye Summer, hello 4th year

its the last week of my summer holiday now, and the feeling that its coming to a close now isnt exactly the best. My elective ended last week and the experience I gained while over there was unforgettable. The lunar new year festivities have just begun, but as always, it is a short affair for my family, all the required visits done in one day. Can't say im a fan of the lunar new year, but it somehow felt good to be around this year, my first new year in 3 years. Also managed to squeeze in a game of golf or 2 during the time that I've been back though I wish I had more time on the course as well as the range.

Well thats all coming to a close now, and 4th year in Med school begins shortly. The requirements this year look quite ridiculous, >90% attendance and filling up + submission of time sheets, thats just crazy, NO TIME FOR GOLF!!!! oh well, shall make do and enjoy myself none the less, thats the only way to make the best of things.Its the year for my BIG exam, just another 36 weeks to perseere through.