med school mumblings...

Wednesday, November 29, 2006

on the way home today, mother goose played casino royale's theme song, chris cornell's you know my name, in his car and the song has been stuck in my head since. it clearly reflects my emotions for today - raw, angsty, loud. many reasons, and i realise that it's been a long time since i last felt like this.

You Know My Name

If you take a life do you know what you'll give?
Odds are, you won't like what it is
When the storm arrives, would you be seen with me?
By the merciless eyes of deceit?

I've seen angels fall from blinding heights
But you yourself are nothing so divine
Just next in line

(chorus)
Arm yourself because no-one else here will save you
The odds will betray you
And I will replace you
You can't deny the prize it may never fulfill you
It longs to kill you
Are you willing to die?
The coldest blood runs through my veins
You know my name

If you come inside things will not be the same
When you return to the night
And if you think you've won
You never saw me change
The game that we all been playing

I've seen diamonds cut through harder men
Than you yourself
But if you must pretend
You may meet your end

(bridge)
Try to hide your hand
Forget how to feel
Life is gone with just a spin of the wheel
Spin of the wheel


what a gruesome song.

Monday, November 27, 2006

first day of emed and it's been quite a day. had the usual briefing, signing of forms and lectures in the morning, before starting our attachment to the resus room. when we entered the room, the doctors had just called it on one patient. then a second patient was wheeled in two trolleys away, a 49/I/M with esrf and rejected dialysis who suddenly had a fit at a coffee shop. was asystole when he was brought in, but they eventually got him stabilized. he never did quite wake up after that and was breathing only with the help of the respirator, so his family was informed about the situation. they understood, and i think the doctors intended to extubate him later, but he died before that.

third patient we saw was a nice chinese gentleman who actually was an outpatient here at the western hospital. after a routine follow-up blood test this morning, he was told to come back because his potassium was nearly 7. he was quite well, and we chatted with him for a bit. then suddenly he started to develop some chest "tightness", which progressed to pain. the nurse did an ecg, and guess what? st depressions in v3 and v4. like, wow, right in front of our eyes! some morphine, gtn and aspirin later, he was a little better. told him to please inform the doctors if he felt any discomfort anywhere, because if we hadn't been talking to him, he wouldn't have mentioned that he was having chest pain!

)edited)

death in the emergency department is more unpleasant and sad than in the wards, simply because most of it happens when you least expect it. if there's an elderly lady who's got pneumonia and a host of other co-morbids, the family is prepared for the eventuality. no one ever expected that indian gentleman to go into asystole. it's the suddeness of it all which upset me for a while after i had left the hospital, perhaps because i've been through something like this. i guess we all must get used to it, but do we?

Sunday, November 26, 2006

got my first pair of pointes today! they're bloch serenades, and they're very very pretty. i still need to sew the ribbons on and break them in, but oh i could stare at them all day. you must excuse my indulgence, for i never thought this day would come.

here's a picture of it taken from the bloch website. aren't they gorgeous? of course being worn on such fantastic arches does enhance their beauty. man, i can't wait to start ballet.

i start emergency med at the western hospital tomorrow. (side note: can someone please explain why i keep getting sent to the western hospital? it's awfully far away for me.) hope it'll be a good posting since i've heard quite a bit about it. ambulance day run this week, night run next week. will blog about the experience as soon as i can.

my holiday schedule is starting to fill up and, save for one item on the list, everything seems to suggest a great christmas holiday this year.

Tuesday, November 21, 2006

today at the angiography room of the crossroads hospital, i stumbled upon a bunch of j1 students shadowing the radiologist for a day. representatives from the "familiar" schools were there. i was thinking, whoa, they sure are starting early aren't they? at j1 i was enjoying my holidays volunteering and caroling, not sitting around in an angio room watching on a monitor screen a picc line being inserted! heh.

radio is really cool. being able to look at an image and decipher something from the whiteness/blackness/squiggles is very gratifying, but can be frustrating for us because we're only starting out. we had one and a half hours of chest x-ray readings today, and it was crazy. after each lesion was pointed out, there would always follow whispers of "where?", "huh?", "oh my god!" or simply the smacking of heads. we must have seen nearly thirty sets of cxrs and ct thorax in that tutorial. never imagined that i could have survived something like that. i'm glad we had it though, because now i feel so much more comfortable with cxrs. yay.

Thursday, November 16, 2006

it's bye bye psych. finally. not that i dislike psych or anything, but it's just that i think i'm not cut out for it. at all. mcq paper was ok. i misread 3 questions unfortunately, in my haste, so had a couple of marks deducted. in addition, there were some "controversial" questions, and the oxford textbook of psychiatry was read out to show what would the "model" answers be. uh. somehow i would prefer that such questions not come out in an mcq paper, because it forces us into a corner. i mean, why not ask it in the form of an essay question? mcqs should test clear cut stuff, and not trick us into picking the "wrong" answer.

clinical test was all right. got a delusional patient who was a little withdrawn. was asked about treatment, which no one was, so it's either a good or bad thing. hmmm.

[spoilers]

went to watch casino royale after the test! it's not bad, fairly edgy but with your usual dose of bond action and love scenes. daniel craig is a little too chunky for my liking, but i felt he showed the brashness and vulnerability needed at the right time and with just the right amount. the stunts were excellent, and i particularly like the chase sequence in the beginning. the reviews all say that this movie shows a softer side of bond, the one who actually cares about the women he dates, but we never quite dwell on the poignant scenes long enough to feel it. there is one scene where eva green, as bond girl vesper lind, leans over and whispers, "you can have me any way you want," and bond replies that he always thought she loathed him and so on. really felt that the "emotional" scenes were either too short or too contrived, or maybe i was just expecting the grittiness of batman begins. heh. the movie was a little too choppy as well, and you get the feeling you're going from one bond adventure to the next, and that all of them are just vaguely tied up to the terrorist plot. some historical "inaccuracies" too - m talks about 9/11, which means that the past twenty or so bond adventures all happened in the past 5 years!

[/spoilers]

but i nitpick. mads mikkelsen is deliciously evil as bad guy le chiffre, and judy dench is reliably good as m. the locations are absolutely beautiful and made me want to go backpacking in europe again. it was also a brilliant idea to have that catch me if you can-looking opening credits animation. the movie is over two and a half hours long and packs enough destruction and death-defying stunts to keep most people happy. daniel craig effectively silences his critics with a respectable performance, and he'll probably turn in many more in the years to come.

and now i must comment on the behaviour of the couple sitting behind us during the movie. girl loves ramming her shoes into the seat in front of her, and guy shows off his knowledge of casinos by announcing the value of each chip whenever it's shown. glares and shushing don't work at all. why do these people come to the cinema at all? why don't they install a movie theatre system in their flat so that she can wear down the points of her shoe and he can say " two hundred thousand!" or " five hundred thousand!" as loudly as he wants? i'm not blind; the chip is eight feet wide on the screen so i don't need someone to tell me what it is, thank you very much. ugh.

what could be worse? ah yes - shallowness. few things irk me more than this, and i want nothing to do with it.

Saturday, November 11, 2006

random musings:

1) i just had to laugh when i saw the trailer to the movie "colic". the tagline says, "when he (the baby) cries, someone will die." it's hilarious, it's lame, and it's inane. what's next? "dyspnoea"?

2) high of the week: to have a patient tell me that i was meant to be a doctor and that i would later touch and bless many people. she's bulimic, not psychotic or anything, so that certainly made my day.

3) low of the week: having to apologize to someone because someone else more senior got things a little mixed up. sigh.

4) i'm looking forward to emergency med posting, and the two week break after that. med school sure is zipping by rather quickly.

5) some people are just plain weird. like, very weird. i don't profess to be very normal and sane, but oh, this kind of weirdness is in a league of its own and is irritating the heck out of me.

6) my splits suck. i can only hope that i'll be able to go down completely by june next year. meanwhile, i'm learning some of the cool things you see on so you think you can dance? i obviously can't do them well, but it gives me childish delight. i wish i could have lessons everyday.

Wednesday, November 08, 2006

you know christmas is coming when the piano playing kids in your neighbourhood pound out carols on their instrument with the ssame zest as they do their bach and mozart.

it's amazing how a person's family background can affect a person. psychomed has shown me just that. met a patient yesterday who related how his parents pressured him as a child to perform well in school, and who, if he didn't, was caned for every mistake he made. this happened when he was in primary school, and when he was in secondary school, he felt he was unable to cope with the workload and so attempted suicide. now he's in a tertiary institution and the people around him, including the lecturers, are full of contempt for him because of what happened. it hurts him, and he feels that his condition is being trivialised. he's struggling to keep his dignity amidst the hostility he is getting and this is making him very depressed. granted, this is only his side of his story, but he can't be making up very much of it.

my heart went out to him, because i am, after all, a product of this ruthless rat race called the singapore education system, and in many ways i wished i never had to go through it. sure it gave me a strong foundation is maths and science, but i've got a niggling feeling that i should have learnt more and developed a more healthy interest in things like literature and history. i look at my younger cousins now coping with the numerous and massive changes in the system, and hear stories about how parents are forcing their primary school kids to find a niche for themselves in order to secure a place under the direct school admissions and i can think of only one word - scary.

spent a couple of days at the institute of mental health last week. it wasn't scary or terrifying or anything like that, but i would say that a bit of me was shaken to see the patients. see, patients admitted to imh have more severe conditions than those in the psychiatry wards in the peripheral hospitals, and their symptoms are correspondingly more dramatic and obvious. one banged the table and screamed loudly for his father and God midway through our interview, while another shared with us his worry that a certain member of parliament was being cursed by people on the streets. this was very real to him, and it disturbed him so much that he swallowed half a bottle of clopramazine so that he could stop hearing the voices.

i salute the people who work there, because it ain't easy.