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.