Category Archives: Medicine

Lady, your son doesn’t need any treatment. YOU DO!

So, I was working in the ED yesterday because my preceptor is the VMO on call for this weekend. A mother brought in her son who has a small laceration on his chin.

Mother: HELP! My son is injured badly! He won’t stop bleeding.

Child wasn’t crying, but wasn’t saying much either.

Me: OK, I’ll just get you to fill in the form and I’ll triage him in a sec.

Mother: BUT HE’S BLEEDING! HE’S GOING TO LOSE A LOT OF BLOOD!

Me: Sorry, we have a spinal patient needing more attention at the moment.

I went off to help the patient with the ?cervical fracture. Came back to see the lady and her son after 10 mins.

Me: OK, you can come in now. *lead both to the procedure room*

Mother: I’m afraid he may have broken his jaw when his chin landed on the cement block.

Me: *assessing the jaw and playing with the child* Can you point to where the pain is?

Child points to the chin.

Me: *pressing around the mental protuberance* Is it painful here?

Child shook his head. I went ahead and checked for any other injuries. Child only had a superficial laceration about 2cm length and 6mm deep on the mental protuberance, no discomfort other than the superficial injury itself.

Me: OK, it looks like your son has just got this laceration. We’ll give it a good clean and then we’ll glue the wound.

Mother: I think he needs an x-ray. You can see that he is in pain.

Me: Look, I’ve examined your son and he is not complaining of any pain to me even when I pressed around his wound. I don’t think he’ll be needing any x-ray.

I left to grab some saline and skin glue. Came back, gave his chin a good wash and proceed to start gluing.

Mother: Oh, aren’t you supposed to give it a clean?

Me: *thinking ‘lady, you should have been watching me instead of texting the picture of his wound to your relatives” I just did a minute ago. *kept gluing*

When I was done, the lady asked if she could also get his prescription of the preventer med for his asthma.

Mother: My son has been having asthma attacks recently. I haven’t given him his preventer for almost 2 weeks cos the GP has given me the wrong dosage for his preventer.

Me: *thinking surely this lady could have gone in for another prescription* OK, I’ll check. *went to the medication room to look for the same med, which the ED doesn’t stock, but there was an equivalent med*

I went to check with my preceptor if the substitute med was appropriate, which he said yes, and to the mother to see if the child had specific drug allergies, which he didn’t.

Me: Well, we don’t have medication A, but we have got medication B which essentially does the same thing.

Mother: I don’t trust you and that medication. *went into a rant about how she would rather not give him any medications than accept medication B, how the medical system is so corrupt and inefficient, and how the doctors know nothing whatsoever.

Me: !!!

 

Some days, I just wish that there is a plague that targets stupidity and ignorance.

Tagged ,

And my new life has started…

Hello WORLD, I am back.

After grueling months of exams and the move to my rural placement in Leeton, I have finally gotten my life back. I would rather not talk about the exams just because everyone would probably know how the word HATE does not justify my experience.

Leeton, where I am starting my year-long rural placement, is a town with population of 11,000. So far I think this is the smallest place I have lived at. Another med student and I have been given a heritage cottage to live in courtesy of the council. I must say, I love this little cottage. Two good sized bedrooms, a cozy lounge, a modern kitchen and a large bathroom, oh and some olive trees and rosemary bushes in the yard. I may need to learn how to pickle my own olives. Leeton is pretty much a foodie heaven; yippee me! The largest producer of citrus in the Australia, headquarter for SunRice and Berri Juice, a lavender farm around the corner, what else can I ask for?

Placement-wise, I have had a session of parallel consulting, which has been pretty interesting. I feel like I probably need to have a separate post for this purpose. In the meantime, it is almost bedtime and I have to go.

Cheers,
N

And here comes the third year…

I can’t believe it that:
1. I only have less than 2 years before I graduate (hopefully if I pass the mid-year exam and OSCE)
2. I’m in my 5th rotation out of 7

For those of you clueless as to what I am up to, I had my renal medicine rotation at the Wollongong Hospital before the Christmas break and now I’m in Nowra doing general surgery. Renal medicine was very exciting to the point that I am also considering renal medicine as a career path in addition to paediatrics.

Renal medicine really taught me to be very well organised and meticulous in my approach. We sure had a lot of patients in the ward and it was hard enough trying to remember when Mrs. A had her last dialysis or if Mr. Q’s creatinine has come back normal. Every morning 0800hr start, we started checking all the patient files for tests or PACE calls or nursing report. It was very administerial, but I had a lot of go’s at interpreting test results. I also ended up getting a lot of practice at doing cannulation and clinical examinations (although I didn’t do any examinations of the nervous system).

I’m starting my week 3 out of 5 for my general surgery rotation and I must say that I think I am getting a lot more comfortable with where I am. I sure need to do a lot more practice with my clinical skills, but who doesn’t? Prior to this surgical rotation, I’ve only had Urology rotation under my belt, which was OK (with the exception that Urology in general seems to be very privatised although medicine shouldn’t be, but that is another spiel altogether). I was expecting short ward rounds and interns or residents running around like headless chooks because the consultants and registrars are never around. I was pleasantly surprised to a very supportive team; consultants who are willing to give their time to give tutes or even just let you scrub in for procedures, registrars who wouldn’t stop bombarding us with questions and tips for the OSCE (I meant ‘bombarding’ in the best way possible, my reg is great, I wish all regs are like him), residents and interns who would put a little bit of their time to go through the med chart or fluid balance chart with us. In this rotation, I’ve taken my niche as the vampire (bloods, cannulation), the scriber (I even got to scribe for a PACE Tier 1 call), and the bedside chart man. GSM, can all my rotation be like this one please?

Random facts:
1. I got a Sony Ericsson XPERIA X10 over the break as a present. It’s an android phone and I’ve grown accustomed to checking my email and FB every morning when I sit in the toilet.
2. Yes, I sometimes look at my poo to try to guess what it is in the stool chart.
3. I do wash my hands and disinfect my phone after using the toilet.
4. I also downloaded a WordPress app on my phone, so I should probably start updating my blog more frequently. (Although not my food blog, because it is gross to blog about food while sitting in the toilet…)

On that note, I’m out.

Byes.
N

Paper A Dissected

I finished the first paper today, so a la UOW GSM feedback, I’ll give you the run down.

Subject: Paper A

Description: modge-podge of modified essay questions (15 main topics to be exact)

Highs: the amount of cardiovascular and haematology questions were great. I think those are my strong points and I felt very confident with my answers. The blood pressure and anaemia questions were particularly my favourites as I covered them in enough details. One of the neuro topic was well answered as well (I think); it was on Parkinson’s and I managed to work out/draw the entire nigrostriatal pathway. I was very proud of myself.

Lows: the rest of neuro, I was iffy about. There was a whole topic on migraine based on one GOAL (our online learning activity). ONE and no more. Musculoskeletal was quite confusing, especially the anatomy of the vertebrae. I was not happy with that.

How do I think I did: I’m definitely more comfortable than I did last year. I answered all questions except for the sumatriptan pharmacology. Knock wood, it’s a pass.

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Self-grade:

Creativity: A-

I managed to write a story about how two friends manage to pass rhinovirus to each other while one was sneezing. I used a lot of colours for this paper. Pink, purple, green, orange, and black. Could have benefited from more colours though.

Efforts: A-

I answered all questions and definitely used all the spaces I was given to show off my knowledge.

Time Management: B-

I had to go to the toilet twice, the first one I walked to the toilet, the second I sprinted. I think I could have been more focused in the exam. I also didn’t realise that I skipped an entire topic until 20 mins before the end of the exam.

Stress Level: B

Stressed-ish, but not as much as last year.

Overall Grade: B+

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Wish me luck for the two papers tomorrow!

Choice

I know my last few posts have been pretty gloomy. Well, let me update you with what has happened for the past week. Turns out I did not pass my second attempt at the lower limb clinical competency and I have to schedule an appointment with NH who is in charge of the clinical skills. I emailed her Tuesday and I haven’t gotten a reply until now. I have until the 29th of June to redo it, but I have to discuss it with her first. I have the phase exams in less than 3 weeks as well. You’re probably thinking: OH NOES. HES GONNA FREAK OUT MORE. HES GONNA GET MORE ANXIOUS.

Actually, not really. I think managing stress is about choice. I have the CHOICE to focus on my exams instead of dwelling on the fact that I have to redo my clinical competency for the third time. I CHOOSE to not get stressed out by things that I can’t control (i.e. waiting for the reply from NH). It is my CHOICE to not deem my entire medical education as a failure based on the little things that I can improve on.

Ta,

N

p.s. I apologise for being overly psycho-analytical with my life a couple of days ago. I do have some anger and bitterness, I suppose. Nonetheless I CHOOSE to move on with my life and see my past as an experience I can learn from.

my life summed up as a PPD

PPD = personal and professional development

See, at the UOW GSM, we have this thing called PPD. We have to do an assignment to reflect on something that we have learned thus far in medicine that would help develop us as a doctor. For me, it is like a cleaner-and-more-politically-correct blogging. Anxiety has always been something that I struggle with and I can’t help reflecting on it for the past couple of weeks due to several incidents that have happened. These are not necessarily what contribute to my anxiety, but I’ve just been in a reflective mood that I can’t help being reflective in almost every segment of my life.

SELF WORTH

All my life, I have always had that thought of being not good enough for everything. I am a middle child and I am sure that if there is such thing as the clinical diagnosis for middle child syndrome, I would be its poster boy. Growing up, I always felt that I was never good enough for everything; that is exactly the feeling I’ve tried to fight. My extended family always compared me to my older sister and younger brother; ‘why are you not as smart as your sister?’ or ‘oh look at your brother, isn’t he so cute?’. I had to constantly fight for people’s attention and that explains everything about me now. I listen to music that other people wouldn’t listen to and as soon as the artist becomes popular, I would lose interest. I do things that make me unique like taking dancing lessons as well as doing martial arts. Not that I am an attention-whore, but my upbringing has programmed me to be someone who always lusts for attention.

MOM

At one point in my life, I really hated my mom.  She always has this bitterness towards my dad’s extended family and it didn’t help that the first 2 years of my life, I was raised by my grandma (dad’s mom). Physical punishment was normal then and it would be a lucky day for me if I only get beaten once. I had nightmares about my mom and they were all the same. Me in a 4 by 4 room running away from my mom who was trying to eat my brain. I would say I had that dream constantly until I was about 13.

Another time, when I was in the eighth grade, I had to help my brother study. My brother doesn’t listen to me, never did never would. Mom was mad at me, we got into a big argument, and by the end of the night, she said something that shouldn’t have been said to a child: ‘I wish that you were never born…’ OUCH. I confronted her about it a couple of years ago about this and we made up. Forgiven but not forgotten; that was 14th of June 1998 Sunday night at 745pm. You can call me bitter, but it’s like when you’ve had a sharp knife pierce through your skin and you bleed. Eventually the skin heals itself, but you would still have the scar as a reminder of what happened.

DREAMING VS. LIVING LIFE

What comes with being a middle child is the dreaming. My imagination always runs wild; starting from having a dessert bar to building my own ultra-modern and monochromatic house to thinking about food combinations that can potentially work well together. I think my dreaming is what kept me going and distract me from living my life. Being a child who really hated being home, dreaming was my escapism. I think that might have contributed to the fact that I plan way ahead for my future despite having a somewhat disheveled present life.  I’ve thought about this a lot in respect to my clinical experience. I lack an outline in general. I’m so focused on the endpoint/my dreaming that I get disoriented. I don’t have an outline that I can easily follow in clinical skills. I freaking cook without recipes and I make stuff as I go. Clearly I’m living a sad disorganised life.

SELF LOVING

The last thing that I could think of was the lack of love for myself. Being a middle child, I couldn’t help feeling worthless. I sometimes felt that my parents didn’t love me and that my siblings were more important to them. How has this affected my life? Well, the most concrete thing would be the condition that my room is in. It is in an utter mess, yet I would rather clean this entire (share) house instead of cleaning my own room.

Well, I think that’s enough PPD for tonight…

Mee goreng is a med student’s bestfriend

It’s a sign that I’m getting serious when mee goreng suddenly becomes my staple diet. *GASP!* Food bloggers around the world weep. I know it’s sad, but being book-bound also means less time for me to cook and bake.

I’ve been planning to bake sticky date puddings with butterscotch sauce for quite awhile. I have the dates in the cupboard chopped, but I can’t seem to find the time to make this thing. I just want to be done with the exams, but sadly (or thankfully?), they are still 3 weeks away. Right now, all I can do is tell myself: “N, you’ll be able to cook and bake and try all the recipes that you want to try once you pass the exam. Not that you like cooking with recipes.”

I did get to cook nem nuong and Vietnamese rice paper wraps for our ‘family’ dinner this week though. I actually still have a few slices of the patties and I heated them with the mee goreng. They are actually quite yummy together.

Love,

N

p.s. I’d also like to do a shout-out to this lovely lady for making my week with her chocolate-y goodness and to toast for passing on the chocolate as well as for the massive. You guys are awesome.

failing

“our greatest glory is not in never failing

but in rising up every time we fail”

ralph waldo emerson

I think I know it. I think I know it.

I properly learnt the coagulation cascade today. Sure it was examined in last year’s exam, but I just crammed everything in and had forgotten it as soon as I had my first glass of wine after the exams. It truly is a good feeling knowing what you’re supposed to know in the first place. I feel more comfortable facing the phase exams now. I just have to learn immunology (my worst, honestly) and try to teach myself neurophysiology. And I am off to bed now.

i cried today

today was a clinical skills day. and as always, i felt dumb. prior to last week, i had managed to fail 3 clinical competencies. i just added a fourth one yesterday. i managed to fail one that is supposedly one of the easiest. there was a single word on the circumstances section (i.e. for why a student has performed poorly). nerve.

fml.

we did a teaching session on how to do the cranial nerve exam and i came prepared for it. i did a few practices and then the tutor, a lovely petite english doctor, decided that i should try to do it like in the competency setting. i failed miserably. just like my attempts at everything, my nerve got the better of me. we did a feedback session, some good, some bad. then the tutor asked the dreaded question. am i constantly this nervous. as soon as she asked that, i couldn’t hold it in.

i cried today. may be it’s the exam pressure. may be i’m just too sensitive.

i’ve considered quitting medicine numerous times for this obvious reason. not that i’m not enjoying it but i sometimes think that i’m too fragile for this dog-eat-dog world that is medicine. i’ve constantly asked myself if medicine was right for me. i do have the passion for it and the drive. i don’t know if i have the nerve. i was ready to cut off the cord connecting me to medicine.

medicine has made me feel like an incompetent failure.

i’ve always had to work harder to get to where i am in medicine, especially with the clinical skills. most people walk into the room unprepared and they are fine. i have to spend a few hours for it and still i look like the one who is unprepared. at one point last year, a different tutor told me that i was wasting her time because i didn’t prepare. well. i did prepare.

may be medicine is not for me.

the tutor must have been freaked out. may be it was the first time it had happened to her. a male medical student sobbing like a little girl with a booboo on her knee. i think that 15-minutes crying session was what i needed to keep my sanity. i think i need to toughen up and grow an extra layer of skin. no doubt i still have the thought of quitting. but i think i’ll stick to medicine. for now.

i cried today and it felt good.