whassup with tagboard man?

did my last night call for this medicine posting over the weekend. saw one patient with some very unusual disease but whose presenting complaint and physical exam were rather unremarkable. later we went into the isolation ward to examine a patient who was a case of suspected TB. that was the first time i had to don a mask to protect myself; the last time i needed to wear a mask was to visit a patient with stevens-johnson syndrome, so we wore paper masks to prevent us from making the poor man worse.

anyway, after that patient, the ho had to check on this patient who had just passed away. it was surreal, going into the room, seeing the ho check for pain and visual reflexes, and watching him arrange the bed nicely so that it would be easier on the relatives. the few of us medical students (yes there were four of us last night, much to the amusement of dr d and z) walked out of the room, and strangely, i didn't feel upset or anything like that at all. perhaps it was because i didn't know the patient, or that she was old and so it was "expected" (like how it was when my grandpa passed on), or that it was simply a defence mechanism kicking in. we hung around the nurses station while the ho did some paper work, and we started going through the list of differentials for hemoptysis and hematemesis. just like that. whatever the case, i still think that night duties are good opportunities for us to learn more stuff, especially the practical part. realised last night i'd better brush up on my clerking, especially "speed clerking".

watching the seniors follow the house officers around has made me think of elves and santa. heh. and this year's national song is waaay better than last years.

it's kinda freaky when a patient you've clerked before makes the news for the wrong reasons. if i say any more, it'll probably breach the patient confidentiality thingy, so well, it's both sad and freaky because it's a reminder that there are many aspects to a person we never know about. sad because i've spoken to the person (as have many other people) and perhaps, just perhaps, there was this chance that one of us could have intervened. freaky because no one have expected this to happen and it sends chills down my spine now as i think about it.

talking about freaky, i was clerking one patient yesterday when the guy in the opposite bed started calling out for me to come over. as usual he called me "missy" but it wasn't because of this that i ignored him. i had this gut feeling that something wasn't right, and later i was joined by my male colleagues, who told me this patient had touched a nurse inappropriately, to put it mildly. dr nice also warned me about him. whew. many times when patients call out, it's because they need to go to the toilet or there's something they want us to help them with. pure instinct had prevented me from getting hurt this time, thankfully.

the fifth years are all around the wards these days for their SI "pretend-to-be-HO" program. everyone looks ok after one week, so i think it isn't as traumatising as i imagined it to be. mr black even taught us how to read an ecg, a great help because no one had ever explain the basis behind an ecg. i mean, ecg reading isn't a skill you can pick up "on the job". the rationale has to be properly explained before one can go on to challenge oneself with rabbit ears and whatnots, and that can't be done in a one hour lecture! now i can vaguely read all those squiggly lines, which is an achievement. yippee.

so much has happened in these past three days. monday i saw a patient with huntington's chorea and my journey home was extended due to the train fault, tuesday i was angered into silence early in the morning but was laughing at night after a successful birthday celebration, today...well, today i did something that i'm still kicking myself for. actually it was something i -didn't- do. sigh.

anyway, it's the middle of my first real posting and i'm starting to get a slight inkling as to why people become disillusioned with medicine/medical school and quit/think of quitting. some people already have. yesterday i tried on a pair of jazz shoes as part of the elaborate birthday party plan, and that feeling i got with the shoes on was fantastic. i know it's probably not too late to sign up for classes...

i shan't say more now, cuz all this is probably a passing phase, but over today's lunch conversation i realised i'm not the only one, which of course does not make me feel any better. bleah.

sparrowhawk. quite a bit has been said about it, including our minister saying that we should form the habit of wearing masks when we're sick. hmmm. anyway, let me tell -my- side of the story, which was that my classmate and i were thrown out of wards because no one had told us to get a sticker. haha. luckily we were able to clerk a patient and even speak to her attending doctors who taught us some stuff. it was only later a staff nurse spoke to us. "even the nursing students aren't here, so why are you here?" good question. we mumbled something about no one saying we -couldn't- come and then left hurriedly. it was just as well, cuz we were supposed to go present-hunting that day, so we found ourselves heading for orchard road at ten in the morning. fantastic.

and for everyone out there who's never been masked, one doctor's reaction to it said it all. he looked at his reflection in the lift door and exclaimed," i look like a freak!" and suddenly turned to his friend and gave a roar. haha.

can't believe i took thirteen hours to finish my case writeup. i mean, i've got quite a bit of it down already from the history and p/e. it's astonishing how draining writing up a case can be, and i'm sure my thirteen is not the longest. heh. but i'm glad it's done, so that i can concentrate on the next one.

to keep our spirits up, my sub-cg has turned to an interesting pastime. it's hilarious, it's girly, and can be downright crazy. it's keeping us constantly amused so if you happen to see three female medical students giggling along the corridors of the hospitals, it's just us relieving stress.

it was an epic struggle in mind, to decide if i should go home after lecture today or stay on to clerk. in the end, my lazy/tired/zonked out mind won. when i awoke from my nap just now, i wondered how i have survived the full day clinics the past few months. heh.

saw this guy with a recurrent infection last week. apparently he had gout and concomittant diabetes, but he defaulted on treatment and turned to tcm instead. now, i'm not saying anything bad about tcm here, but in this instance, it was more of a detriment than a help to the patient. since he had joint pain, the tcm practitioner stuck a couple of needles into his shoulder, and it seems that he's got an infection. his upper limb joints are all hurting symmetrically, and there's a large, fluctuant mass on the dorsum of his foot. perhaps a healthy person would have fought off the germs, but after refusing meds for diabetes (30 years according to the notes), they can only load antibiotics into him and hope for the best.

there was also this woman who was newly admitted for a bad fall, and the ho told us to clerk her first while she sent another patient's bloods off, so the three of us set off to meet her. we said hi, asked her what was wrong, and she replied in cantonese. then suddenly, she began to speak a weird language, like she was speaking in tongues! no one could understand her, and her daughter told us not to listen to her. an indonesian maid taking care of one of the other patients in the ward said she claimed that she fell down because she was looking at a handsome man. heh.

talking about handsome man, does anyone think that it's weird for a guy to comment that another is "quite handsome"? i mean, just out of nowhere, to say something like that?

watched "pirates of the caribbean" over the weeked, and i must say, although it's a tad long, it makes for substantial entertainment. johnny depp is excellent as jack sparrow, but keira knightley and orlando bloom are disappointing in their supporting roles. fantastic eye candy yes, but when up against depp's wonderful sense of comedic timing, they might as well have been mute.

going off now for yet another "catch-up" dinner. it's the only secular thing i do that keeps me sane.

bad day today. it rained cats and dogs in the morning, and at the train station i found that the earlier train had stalled, so they had to turn around a ponggol train and put it on the harbourfront line. the train was full of people because there were twice the number of passengers. after two or three stations, the train was completely packed and no one could get on board. for about half an hour a whole trainload of humanity was squashed as the train sped southwards. after that, i got caught in a traffic jam when i was on the bus. it took me more than one and half hours to get to the hospital!

nowadays whenever i get to the wards, one of the first things i do is to check on this young man who's got neuroleptic malignant syndrome. i first saw him when he was admitted on saturday night, and his condition has been getting worse. he could speak when he came in, now he can barely get the phlegm out of his lungs. while his might be an interesting case, it still disturbs me that someone of my age can be in that sort of semi-catatonic state.

then later in the day i decided to go down to see my cofm patient was recovering from a stenting procedure. as i was looking for the casenotes, the nurse on duty started yelling at me, demanding to know which consultant i was attached to etc etc, and saying that those were her patients, so i couldn't come in and look. the initial nasty surprise gave way to anger, because she could have put nicely instead of yelling, and the patients and their relatives were all staring and wondering what extraordinary offence i had committed. i knew it was one of the high dependency wards, but i had gone in yesterday evening without incident -- indeed, one nurse even told me kindly to take a seat while i looked through the file. how was i to know? -sigh- it's just one of those days i guess, but it totally spoilt my mood. oh wells, tomorrow will be a better day...

this should have been posted last week, but i couldn't find the right words. i've finally found them, in the refrain from one of matt redman's songs:

You give and take away
You give and take away
My heart will choose to say
Blessed be Your name.
--Job 1:21

In Memory Of
GY
(1974-2004)

and so the journey ends for germany. they beat portugal 3-1 in one of their best performances in this world cup to claim third place. bastion schweinsteiger stunned the crowd by scoring twice from the edge of the penalty area, and had a hand in forcing an own goal from petit. ollie played his last international match, as did luis figo. ollie was made captain for one final time and did well by saving several portugese attempts at the goal. however he was denied a clean sheet after figo set up gomes for a late consolation goal. after the game they embraced, and both had tears in their eyes. zizou ends his run tonight in berlin, and the curtain falls on their generation of footballers.

did night duty again last night with j and j. ho on duty was a friendly guy who liked to laugh, and it always makes things easier to have an easy-going senior. saw one old man who had refused dialysis and was therefore in renal failure. we tried to ask him questions, but everytime he would do this peculiar thing, which was to pout, blow out a puff of air and then point repeatedly at his mouth. there was no history to take, and the only thing we got out of his wife was that if anyone tried to poke him with a needle he would yell. sure enough, when the ho had to do an arterial blood gas, we discovered that he could speak, but his vocabulary was limited to two hokkien unprintables which he screamed out again and again, even though the needle hadn't even gone in! when we pulled aside the curtains, the entire ward was staring at us. oh well.

we also clerked a twenty year old guy with a history of adhd, who had his third episode of fits that afternoon. he seemed a little slow and not really able to grasp what was going on. his mother was helpful, but she seemed flustered. in fact, some time later we found that he had had another "fit" and had fallen while trying to pee, so his plug came out and there was blood on the floor and the bedrails. there was not much to do but to wait till morning to review him.

last night also marked another first for us - we did our first per rectal. very weird feeling to be doing it. hmmm.

am fast approaching the halfway mark of my medicine posting, and i'm still overwhelmed by all the things i have to learn. it's unimaginable, the amount of information on these conditions. when you think you have a rough idea of a particular condition, someone will surprise you with something new.

will end off with two random things - first, i never knew what hot was till a few days ago, and two, this is a great quote : "You are what you love, not what loves you."

night call on thursday was good. followed two house officers and a medical officer, and saw a young patient with ulcerative colitis who had twice vomited blood in the evening and had to monitored carefully because her Hb had once fallen below 10. another patient had sinus bradycardia discovered when she was about to do her ogd, and a breakthrough seizure patient who kept going on about his medication even as the mo and ho were clerking him. was asked to help take the blood pressure of a patient and was surprised to discover that the cuff at the bedside was much larger than normal. interesting.

there's a letter in the papers today about an indian man with chest pains who went to a large, central hopsital but was turned away. he later went to another major hospital which did an angio on him and found a 90% block in one artery. several articles and letters of similar complaint have appeared in the straits times recently, and i can only say that i doubt any doctor ever wishes or wills for his patient to die, but the failings of the system here and abroad, as well as all of us as humans, will mean that we will never be 100% sure about anything. like our professors tell us, there is no "always" or "never" in medicine.

on to another topic, did you know that the authorities on our little island had once contemplated registering the identities of all bloggers? most fortunately for all of us, they have decided not to. and in a way, that's one reason why i've kept stuff on this blog to a minimal, like shopping and soccer and school. i'm not really bursting to tell stories about the intricacies of working in a hospital right now, but i'm sure in a few years' time i will, and it will be harder and harder to keep such things out of this blog. i do foresee that the existence of this blog will be threatened when, and if, i graduate.

oh well, for now it shall be back to soccer, with germany playing portugal tomorrow morning. klose will be looking for more goals to score, and ollie will be between the sticks for probably the final time in a world cup.

oh what sorrow! germany lost 2-0 to italy in a great match this morning. the scary thing was, i dreamt that they would lose by that scoreline just before i woke up to catch the match. -cue creepy music- i have to say the italians outplayed the germans. some of the german players started slipping and sliding on the pitch, and over the past four years of following the team's progress at friendlies, that is not a good sign. the germans only had 42% of the possession, and i even spotted a defender kicking the ball to an italian player! the game went into extra time after a goal-less ninety minutes, and after the first half of extra time, i went back to sleep. one hour later i woke up to news of the loss. but klinsi has done well, coming in with no experience in coaching, to lead a young team to the semis. guess i'll have to set up my old telly again so that i can watch the third place play off. sigh. it's so heartwrenching to look at the photo of ballack with tears in his eyes.

will be on night duty tomorrow. maybe i can set my first plug. hmm.

could i have asked for more? initially thought that i would not be able to watch last night's match, but my dad managed to find the antenna for our old tv. it took a while to set it up, find out which channel was showing the match, and moving the set around to get the best signal, but it was all worth it.

a 1-1 draw after extra time, and then a 4-2 win on penalties. it was terribly tense, and i felt it. there was another woman around my neighbourhood who kept yelling, and uttered some expletives when the argentinians looked like they were about to score after the equalizer. the really funny thing was that when jens lehmann saved that spot kick by ayala, the dog two floors down howled. heh. der desutche hund. but man oh man, what a match. the germans were persistant enough, even though i didn't think they played as well as they could have last night, and they never gave up. klose became the tournament's leading scorer with his header, and ballack showed the tenacity of the germans when he stepped up to take the penalty. before that in the dying minutes of the game, he was actually limping and reduced to walking pace because of a thigh injury. but when it mattered most, he hit it home. now germany meet italy for the semis next week, and i can get to watch it in colour.

what a good way to end my first week of third year. it has been a rather relaxed week. managed to orientate myself and settle in. most of the patients have been nice to us so far, and are more than willing to talk to us and let us examine them. one patient i clerked has been taking care of his paralysed wife for the past four years. he talked about having to bring her to the toilet every now and then, and remembering to take care of himself while caring for his wife. another patient was still deciding whether to have a stent or bypass done for his condition when i left the hospital yesterday. classmates have clerked patients who attempted suicide or who have had end stage renal failure for years together with other conditions. is it any coincidence that in this one week, two reports have appeared in the papers showing the shortcomings of doctors. it's no wonder that in the resident's room of the cardiology ward, someone wrote a reminder on the whiteboard - "we treat, God heals."