med school mumblings...

Sunday, August 31, 2008

A Backward Glance

it was the last day of grand ol' dame sip for me on friday. some frenzy when three out of five of my patients were discharged - discharge summaries, consultants to be called regarding tcu dates, tracing blood results...so much so that i forgot to tell one of them that he could go home! haha. fortunately the nurses told him soon enough, and he ended up having to wait for some time before his relatives came to pick him up.

no team breakfast because our a con had clinics but the junior doctors and us sips had a nice (and free) lunch seated around some table on level 9. friendly ribbing about our future/intended specialties, mostly between the mo and ho, and more gossip flew across the table, followed by more laughter. i love my team. what a blessing they have been! heh.

so...what did i enjoy about my sip?

1) consultants who are friendly and not impatient when a silly medical student makes a mistake or utters rubbish during rounds
2) seniors who encourage you and let you find your own footing in the ward
3) patients, in my case, cancer patients, who showed me how important it is to have the will to live, no matter the circumstances. patients who, even after being told that there's a recurrence, can still crack jokes. you think that they need strength, but it is us who draw strength from them
4) taking "ownership" of patients - when i call about my patient, it really -is- my patient that i'm calling and responsible for. it's both exhilarating and scary at the same time. and talking to relatives too - it can be very nerve wrecking, especially with an anxious relative
5) learning about myself - having to deal with real, working medicine exposes your strong and weak points, ie things to look out for next time when i start work
6) my little distraction, dr darcy. never expected something of that sort (and magnitude!) to occur mind you, but i'm sure i'll laugh as hard about it years later as i did while recounting the whole story to a friend over lunch today

and as fate, or irony, would have it, dr darcy transferred a patient to my room late friday afternoon. yesh. of all days, it had to be my last day huh. it's a sign, i tell ya, it's a sign. i didn't know what to think when i turned the corner and saw him at the nurses station. lol. and since my ga-ga-ness has been revealed to my cg guys, i'm being teased non-stop. heh heh. anyway, like i mentioned in a previous post, this frivolity is now over, and it's time to focus on infectious diseases next.

bye bye haemato, hello microbiology.

-groan-

what were you trying to say?

Thursday, August 28, 2008

Joy to The World

lots of laughter at team breakfast today, and my ac revealed a humorous side that we've never seen before. it's been an amazing one month at haematology, with a team that has the most hilarious combination of people. we work hard in the day, but after exit rounds, it's gossip and laughter galore! haha.

went to the other haem ward to visit a former patient mr p-. he has nk/t cell lymphoma, and was previously at my ward for chemo. he was hurriedly admitted via clinic yesterday after his pet scan showed up some abnormalities in his mandible. (i can't understand a pet scan, but i can now explain dr d's early-morning hunt for a bed yesterday in the middle of my rounds. ha.) for now, they'll try to whack the cancer with chemo and then aim for a transplant, but meanwhile, he's lying in his bed very comfortably, and was very pleased to see me today. he's a very funny man, given his condition, and our conversation left me in stitches. the odds are stacked up against him, so i really hope he makes it through, at least to the transplant so that he's got a fighting chance.

and another amazing thing happened today - i found out that my sickest patient, this old gentleman with newly diagnosed dlbcl with renal failure, knows how to give the victory sign! for some reason, i was deliriously happy to see him like that, not just because it's looks quite ridiculous to have a 70 year old bedbound patient do it, but also because just last weekend, he was almost destined for an ica admission. and not to mention his family nearly gave me a heart attack two days ago. so i'm really very happy to see him this way. utterly glad.

to suit my mood, i'll post up this video to three dog night's joy to the world. enjoy.

Tuesday, August 26, 2008

Anew

the morning started wrong, started horribly, and for the entire day today, a part of my heart was closed, retreated and i felt lost. lots of questions went through my mind, and they were all half answered.

but just at the end of my day, my patient squeezed my hand. he squeezed because he was afraid, and because he was going to pluck up his courage to start the chemo tomorrow.

and just like that, there is new meaning to what i do.

Sunday, August 24, 2008

Chill Out

mumbler is exhausted. she has spent seven straight days in the hospital, two of which were half calls, and after a short break tonight, will be back again for her last five days in sip. this morning she was astonished to take a glance at the clock to see that four hours had passed since she stepped into the ward. where does time go in the wards?! and the *ahem* perks i was expecting yesterday didn't materialise, probably because i only finished my changes at noon.

had some bits of recreation this week - meeting up with a good friend for dinner, and post-jci party/lunch at st james' power station. am being sounded out for a gathering next weekend, but i'll just have to see if i should choose sleep over it.

had my half call last night, and it was quite interesting since the people admitting the patients i clerked were my favourite folks in the a&e. even more exciting was to work through the presenting complaint and find that the a&e senior had thought of the same differentials. haha. of note was a chronic alcoholic with multiples AORs who had hepatomegaly and an hiv-positive patient who complained of generalised weakness. the latter case was very challenging, because of the nature of his disease, and the inability of either he or the family to give a really good history.

my latest ga-ga-ness (known to only a few people so far) has gotten me reading jane austen's pride and prejudice again. love that book - great characterisation, great story, and great romance, not to mention austen's sharp and witty writing. here are some quotes from the book:
"It is your turn to say something now, Mr. Darcy. I talked about the dance, and you ought to make some kind of remark on the size of the room, or the number of couples."

"Nothing is more deceitful ... than the appearance of humility. It is often only carelessness of opinion, and sometimes an indirect boast."

"Vanity and pride are different things, though the words are often used synonymously. A person may be proud without being vain. Pride relates more to our opinion of ourselves, vanity to what we would have others think of us."
and i'll just the post the link to the video of one of my favourite songs of 2008, indeed that i've ever heard. i associate it with my a&e posting, and listening to it triggers memories of the my time spent flitting from patient to patient in the cramped p2 area (before the lodger ward was opened), ordering macs at 4am and working on my project in the basement. i really really miss those days.

this is sara bareilles' love song. here's the unofficial video:


Head under water
And they tell me to breathe easy for a while
Breathing gets harder, even I know that
Made room for me it's too soon to see
If I'm happy in your hands
I'm unusually hard to hold on to

Blank stares at blank pages
No easy way to say this
You mean well, but you make this hard on me

Chorus:
I'm not gonna write you a love song
'Cause you asked for it
'Cause you need one, you see
I'm not gonna write you a love song
'Cause you tell me it's
Make or breaking this
If you're on your way
I'm not gonna write you to stay
If all you have is leaving I'm gonna need a better
Reason to write you a love song today, today yeah

I learned the hard way
That they all say things you wanna hear
And my heavy heart sinks deep down under you and
Your twisted words,
Your help just hurts
You are not what I thought you were
Hello to high and dry

Convinced me to please you
Made me think that I need this too
I'm trying to let you hear me as I am

Chorus

Bridge:
Promise me that you'll leave the light on
To help me see, with daylight my guide gone
Cause I believe there's a way
You can love me because I said
I won't write you a love song
'Cause you asked for it
'Cause you need one, you see
I'm not gonna write you a love song
'Cause you tell me it's make or breaking this

Is that why you wanted a love song
'Cause you asked for it
'Cause you need one, you see
I'm not gonna write you a love song
'Cause you tell me it's make or breaking this
If you're on your way
I'm not gonna write you to stay
If your heart is nowhere in it
I don't want it for a minute
Babe, I'll walk the seven seas when I believe that
There's a reason to
Write you a love song today today yeah yeah yeah

Friday, August 22, 2008

Fleeting Thoughts

i can't quite believe that it's almost the end of medicine sip - i know i'll be very sad to leave. i'll list the stuff that i liked in an upcoming post (though one of course will not to be mentioned) but let me just scribble some thoughts down now:

today a patient's wife came to update me. background of the case is this middle-aged guy who's a newly diagnosed leukemia, and the family delayed in informing him of the diagnosis because they were afraid he could not take it. his wife broke the news yesterday evening, and so far he's been all right. i'm mentioning this because when i first found out i was posted to haemato, i was a little dismayed because i thought i wouldn't learn much. turns out i've learnt quite a bit, especially in communicating with family members. and it's nice to have relatives speak to you this way, because it means they appreciate what you've been doing.

an interesting thing i noticed about patients is how much superstitions or pre-conceived notions can affect their outlook and subsequent co-operation with the healthcare team. one of our patients is also another newly diagnosed leukemia, and chemo is of course indicated as soon as possible, since his bone marrow is filling up with useless cancer cells. the longer he delays, the harder it will be for the chemo to be successful in clearing the cancer cells. but guess what, he wants to wait till the seventh month (hungry ghost festival) is over before receiving chemo, and that would be in september. it can be hard to understanding sometimes, even though you try very hard and you give your all, if a patient brings to the table beliefs that clash with your desire to heal. this same patient even backed out of a hickman line insertion at the last minute because he was afraid of the pain, despite having been reassured that the procedure is performed under local anaesthetic. perhaps it's denial (he did break down in front of the whole team the morning after his diagnosis) and this is his way of trying to regain control of his life since fate so cruelly took it away from him. either way, it's still very frustrating to have to overcome this barrier which medical school never prepares you for. in the books it's always a protein or a receptor or molecule that is your enemy, but in real life, sometimes, it's the patient himself who is your greatest hurdle. and so, i'm very grateful for this posting because i see more clearly now the purpose of it all, and hope to be inspired by my experiences here.

it's back to the wards this weekend - am on passive haemato call tomorrow. someone in my room has been listed as DIL, so i'm keeping my fingers crossed that he doesn't need resuscitation or an ICU admission!

but going back tomorrow (specifically tomorrow) might bring some perks. and yes, both meanings of the word apply here. heh heh heh.

Wednesday, August 20, 2008

Midway And A Crisis

mumbler is just past the midway mark of medicine sip, and so far, she's been quite happy. it's a luxury looking after only a few patients, and being able to devote time and energy in getting to know them, especially since they are all cancer patients. mumbler knows that when the work starts next may (it had better be may!) she probably won't have the chance to do that, so this experience is really precious.

note to self:
i'm glad the current frivolity will have to end soon. i honestly have no idea what i'm getting myself into with all this. no benefits, no positive outcomes, only a perplexed mind and a confused heart.

(i really have to stop being cyptic, even though i know i can't help it.)

Thursday, August 14, 2008

Flashback

mumbler walked past a singing busker outside her subway station on the way home today, and it triggered a memory.

a memory of me standing at the corner of union square in san francisco one chilly evening, listening to a lone man play the romantic theme from the godfather on the saxophone. the notes pierced through the night, and even though i wanted to hurry back to my room, something about the music made me stop to listen. music so beautiful and so perfect, yet so tragic that it stirs something deep in your heart, begging an unfathomable question that needs to be answered, but you know never will.

Monday, August 11, 2008

Squeezing It All In

so, i've got lots of random things to say, i'll try to keep this short. plus mumbler's post call, so her brain is all cob-webbed at the moment.
  • re: previous post, mumbler is ok. it was just one day, and a good lesson learnt. hopefully she'll be a better doctor next time. right now, everything is fine (thanks uncle) though she's still trying to keep up with complexities of the treatment of leukemias.
  • call was pretty good last night. lots of admissions, and weird stuff that you get called for in the middle of the night. one nurse even made a most ridiculous statement ("so if you can't come now, shall i call the consultant to give the first dose?") which po-ed everyone . but at least the nurses in the grand ol' dame help you with the plugs and bloods first, and they're quite good at it. ho was nice, and a kindred spirit in terms of intended specialty. haha.
  • watched red cliff and the x files movie right before i started sip. red cliff was not bad, but was very disappointed with the x files. had been expecting more, since chris carter wrote, directed and produced it. a more detailed review will be up soon.
  • mumbler is happy that she set a pink plug today, given the misses of last night.
  • singing with the choir people again on national day was fantastic. ten years on, we still remember our parts, our lyrics, and where to breathe. we were so young then - a motley crew of schoolboys and schoolgirls who had 'toot' hairstyles and hemlines that fell below the knee. now we have a doctor, a psychologist, a financial analyst and a marketing exec in our gang with the rest graduating soon, and i'm happy to say that our fashion sense has improved. how far we've come!
  • i wanted to ask this question four years ago, but it was too hard. it isn't getting easier, but i'll need to know - do you still?

Friday, August 08, 2008

So You Had A Bad Day

mumbler wants to change her status on facebook to "having hell today" but she can't because it's banned in the grand ol' dame. she'll probably meet worse days next time, but for now, as an sip student, it's hell.

Thursday, August 07, 2008

And It's Straight Out Of A Novel...

amidst the rounds and cytotoxic drugs and funny patients + doctors + nurses, mumbler has met mr darcy. oh, make that dr darcy. those hair, and those eyes! why, he even has....sigh. mumbler is sad she can't write more, because the grand ol' dame is a small place if you know your way around, so dr darcy shall remain unnamed and no further description shall be offered.

on the aside, mumbler is going to make sure she enjoys her national day holiday, because she's going to be on active call this sunday.

Monday, August 04, 2008

The Next Level

mumbler started her first day as a student intern today in the haem ward of the grand ol' dame. the morning was spent settling paperwork and attending a most chiong hei (long-winded) course on how to use the ee-em-are and eye-soft programs. after lunch, we met the doctors in our team (one of whom i met in a&e woohoo!) and everyone, including the nurses, were very friendly to us. heh.

so it's off to work early tomorrow to pre-round before attending the ho/mo teaching. oh, and mumbler's going to be on call for two weekends - one active (sunday) and one passive (saturday). yay.

Sunday, August 03, 2008

In Summary - The Signs

click on these pictures to read (between) the lines. heh.

fear factor - the notice outside the mummy ride at universal studios. the list is scarier than the ride itself!

zen sarcasm - found on the door of the ladies in a thai restaurant in la. includes lines like "don't be irreplaceable. if you can't be replaced, you can't be promoted" and "generally speaking, you aren't learning much when your lips are moving."

how to... - eat a malibu mussel and clam. found on a malibu pier.

finally, a cure - an oxygen therapy sign at six flags magic mountain.

let's get out of here before the kids come - a sign in chinatown, san francisco. i wonder how things were like before it was put up. adults jostling with kids at the playground?

where can we drink? - union square bans alcoholic consumption, but it is still a place where the homeless congregate every night.

big brother's watching - sign reads "your picture and voice may be recorded on this vehicle." on a san francisco city bus.

my cartoon life - sign warning cyclists of the danger of the road. outside a stanford dorm.

and you call singapore draconian? - sign along the perimeter of the united nations compound.

the most 'doh' sign - of course you shouldn't put your kids on the ledge, unless they're part of galileo's experiment. from the observatory deck of the empire state building.

wha? - don't ask me what this sign means. seen along fifth avenue, near the met museum.

big brother's everywhere - sticker reads "all occupants will be photographed." seen in a new york city cab.

you've gotta be kidding me - for the grand finale. the most ironic poster i saw. seen at the times square station in new york city.