torrential rains + disrupted internet services + cofm report make for a very boring and miserable post christmas period. did not realise how much the net is a part of my life until tuesday. spent the past few mornings watching anderson cooper on cnn. he's quite good - smooth delivery, straight talk and the looks to carry a nightly show by himself. there was supposed to be special hour where he talks about christianity in america, and i was interested to hear what it was all about, but it was cut out of the asian feed. instead, they showed yet another program on gerald ford. ugh.

hilarious bmj article - "proof" that surgeons are better looking than physicians. the paper even has lines like "Two additional physicians were dropped from the final analysis because of the poor quality (technical, of course) of their pictures" and "The best known alternative published in the literature (asking a mirror, "Mirror, mirror on the wall, who is the fairest of them all?") works only for queens, a notable shortcoming of this test."

and this letter couldn't have come at a better time when doctors are being whacked left and right in the forum of our esteemed national paper. the war of words will probably never end, but i'm glad mr koh has put in a gentle reminder of sorts.

my hols are coming to an end! boohoo. it's been a great, jam-packed hols though, and the good thing about having a short vacation is that you treasure every minute of it.

the week started out with meetings for the cofm project which went pretty well. even better was that some of us had the time to go down to ikea tampines to explore. the cafe is about four times as big, and they've introduced this food trolleys where you can stack up to 3 trays. real cool. the food's just as delicious as at alexandra and the chicken wings more finger-licking good than a certain fast food chain. yum! we took a walk through their self-serve shelves/warehouse, and my, the place is huge man. humongous, gigantic, enormous. i don't think there's anything quite like it anywhere else on the island, so if you've got nothing better to do, go explore the place!

over the weekend i had caroling sessions and parties. what could be better than singing and eating? heh. joined the catholic medical society for their caroling sessions and the experience has been nothing short of amazing. as usual the altoes were kinda drowned out by the sops and basses, but who cared? i had lots of fun singing and *ahem* discovering people's hidden talents. the food was really good too. i've stuffed myself with lots of turkey and ham and log cakes these few days and my neighbour's just gave us another log cake yesterday. the gluttony isn't over just yet.

on christmas eve ms amoeba threw a party with the theme "nightmare before christmas". i came as the corpse bride, mother goose as a donation collector and someone else ( i can't think of a code name for him at this moment!) came as the crazy medical student, complete with bandaged head, ketchup-filled syringe and mask. we had a great time barbequeing and eating. some of us even started a game of catch and we were screaming and running through the void deck like little kids, nothing like the prim and proper "trainee doctors"or adults we're supposed to be. too bad i was in heels, or i could have run faster! heh.

i've got one more caroling session to go before the season ends. happy holidays everyone. =)

and so emed is over. on the feedback form i circled "6 weeks" as my preferred length for the posting. if emed integrates all the various specialties in medicine, we should spend more time rotating through it! anyway, the western hospital groups are indebted to prof ecg for guiding us through all the squiggles. he has amazing stamina when he teaches, and in the last week we had several tutorials that went all the way till 8pm! what a blessing it was to have been taught by him. heh. i must say too that the other docs in the department, including the mos, made our 3 weeks there very memorable. i actually felt a twinge of sadness when i handed over my access card after my test...

in the evening i finally had a chance to wander around the malls. i realised that i spent most of my time during this posting in the windowless er of the western hospital, and so it was such a great feeling to walk into shops to look at skirts and nail polish. went to see la sylphide by the sdt, and had dinner at thai express before that. if only the ballet was as good as my meal. i must say the male dancers are technically much better than the females - their grand jetes were better, and i did see a member of the corps de ballet fall off her pirouette and another struggle to maintain her arabesque. the sets were quite well done, and the young dancers had enough spunk to make up for any shortcomings. the last time i watched a ballet performance was in primary school, so i did kinda enjoy it.

the holidays are finally upon us. time to finish my writeup, cofm project, and prepare to embark on new things in the new year. it's time to rest.

today was yet another reminder of the unpredictability of life, and how as doctors, our job is to treat and not to heal.

a 57 year old guy was brought in by ambulance for shortness of breath, some pain in the shoulder but no ecg changes. was put in the p2 area until a very sharp nurse noticed some st elevations, and he was pushed to the p1 area. a while later his bp started dropping, and he went into ventricular fibrillation. repeated attempts were made to cardiovert him but he kept going into vt/vf. meanwhile the cardio reg was called, and we medical students took turns to either bag or administer cpr. he was rushed to the cath lab where the cardiologists tried to restore blood flow and get his heart beating again. several times his heart would come to life in a valiant effort to hang on, but it eventually stopped, two hours after full resus measures were begun.

the group of us were there with him, from the time he was wheeled into p1 all the way to the cath lab. initially, other than the pain, he was alert and oriented, until his bp started to drop. our job was to prepare the adrenaline for the doctors, and we must have used up tons of vials in the process. by the time we were in the cath lab we had run out of the small vials, and had to break open the bigger ones. it was crazy, but it was sad too, especially when we could see on the screen that his heart had stopped beating. for some time there was some nearly imperceptable movement, but that too later stopped.

this was certainly an exprience for us. we were giving cpr, bagging the patient and syringing the drugs. and we must have been quite a sight when we wheeled him out of the ed and out onto the corridor. most of us were trailing behind, trying to run and fill the syringes at the same time. it was exactly like how you see it on tv, where the patient is pushed down an infinitely long corridor and the nurses yell, "coming through!" only this time, it was real, and there was to be no happy ending.

what a day... and night it has been. had the emed clinical case conference in the morning, followed by a 4 hour tutorial on poisoning in the afternoon. then it was time to head home for a shower and some dinner before reporting for my ambulance run.

i had been told to expect a slow night, but it wasn't that bad. had a total of five calls, and still managed to fit in an ambulance breakdown in the middle of it all. 3 of the cases were because "patient was unable to walk", turns out that they were elderly and had been vomiting which probably explains the lower limb weakness. the fourth patient had a sudden onset of vomiting, and when we went to his place, we found that he was actually coughing out yellow phlegm! not sure how it started but apparently it had been going on for about half an hour before his female "friend" (that's how she described her relationship to him at the hospital) called for the ambulance. the fifth was an assault case which brought us to the fringes of seletar camp. it was the typical saturday night drunken fight between two construction workers, but only one wanted medical treatment for his injuries.

so it was quite a night, especially after the driver found out on arriving at one of the locations that he was unable to engage the reverse gear. a back up ambulance had to be called and meanwhile the poor old lady on the stretcher kept retching and complaining she was feeling giddy. the backup came and left, and we had no choice but to hang around and wait for the mechanic to come and then fix it. altogether we spent three hours in the middle of pasir ris with nothing to do, and that was really uncomfortable because i couldn't really sleep. thank goodness for the radio function on my mobile.

it's been an interesting experience accompanying the paramedics on their runs. whoever came up with the idea of having it as part of our emed curriculum is a genius because there's so much that i never knew about activating the emergency services and rushing a patient to hospital. for instance, it takes less than half a minute for the ambulance to be on its way after the alarm goes off in the paramedics' dorm. fantastic. and paramedics are a wonderful bunch of people. they're funny and crazy during rest time, but when they arrive on the scene their ability to assess the situation and give the appropriate care is commendable.

emed is ending. have to get ready for the end of posting test, which includes a viva section. -groan- i wished emed were longer! i think most of us would like to have at least one more week on this posting, and to have other postings cut short. oh well, but i guess some people on top want to hang onto the super long postings and leave us to crash course our ecg readings during emed. ack.

fainting people + singing patient + stab wound victim with intestinal evisceration = one heck of a day.

saw some pretty sad cases today.

first patient we saw when we started our shift was a gentleman in his forties who was run over by a forklift and so suffered a near amputation of his left ankle. ortho came down to have a look, and apparently the decision was made to perform a BKA. i haven't done my ortho posting yet, but i can't help but think that it's a rather depressing job to have to amputate people's limbs.

next was a 12 year old boy who fell from the second story while playing hide and seek. landed on concrete ground and sustained multiple skull fractures. the last i know, his GCS was 5. they intubated him (but not before he puked out his lunch in the resus area) and sent him off to paediatric surgery. will have to follow up on him, but i sure hope he'll eventually get better.

third case was a 25 year old lady who swallowed half a bottle of shower gel in a suicide attempt. it's not the first time she's done this, and it's quite likely she'll do it again. she seldom returns home and sleeps out in the open with a male friend. she's on psych followup here at the western hospital, but has stopped taking her antidepressants because she doesn't like to take medicine. her hair was oily and her fingernails and toenails had all sort of grime trapped under them, and there was this stench around her from her vomit. she looked so alone and lost in the sea of trolleys and activity in the p2 area, and i wished i could have talked to her longer, but the doc came to look at her and we were called away to look at scans. not sure how she reacted during the pysch consult.

just got word of some sad news about someone. life is unpredictable, no? so it doesn't matter what happens to my pharmaco test, or any exam for that matter, because it's the people around you that matter.

pharmaco ca is days away and i haven't really studied for it. interestingly, i'm not too worried about it, because i've got emed to engage me and keep me happy.

did my first blood gas and culture today for one of the several drowsy patients who came in to our ed this afternoon. the other students also got to perform procedures like catheterisation and plug setting, so it was a rather fruitful day for all of us. my first abg wasn't successful. put the needle in and ended up a little too deep. fortunately prof ecg was there to help. heh.

bring it on, man.