Last Holiday

the end of break
so mumbler's last proper break in med school has ended. wasn't as jam packed as the previous one, but at least she got to cycle, bowl, watch movies, pub and shop shop shop. the paeds test kinda took away some of the fun, but i can't complain, can i, though i'd like to ask how does a picture of a kid with b/l peri-orbital bruising + pallor = neuroblastoma?! like, huh?! methinks this is a question that will haunt me till i retire. haha.

ethics
since mumbler has to retake her ethics test this thursday, here is a case in point that she heard about recently:

young bangladesh construction worker.
presents with 1) atypical chest pain and 2) loss of weight over 5 months.
on examination, noted to be cachexic and to have massive, non tender splenomegaly extending into the right iliac fossa.
bloods: hb 10.9 tw 445 (myelocyte line, blast cells 4%) plt 460
impression: chronic myeloid leukemia

in most cases, plan is to to a bone marrow aspirate(bma) with trephine, and to start on glivec. but in his case, given his financial and social condition (glivec costs three grand a month, not including the cost of procedures and other medications) all the team can do is to deal with his leukocytosis...and send him home.

would someone like to discus the ethics of it? i don't blame the doctors - which doctor wants his patients to die? but the truth of the matter is that we can't pay for everyone's treatment, and while we mug (yes mug, not discuss or debate, but mug) for ethics, we have to come to terms with such situations as practitioners of medicine.

random

• mumbler can't believe that she sent someone home yesterday without thinking of jone's fracture as a differential. argh! lesson learnt.
• and mumbler misses her care group seniors!!
• totally random, but here's a clip of hugh laurie as shakespeare and rowan atkinson as his editor, in a skit about how the line "to be, or not to be" came about in hamlet. hilarious.

"all i'm saying shakey" really takes the cake, doesn't it. heh.

It's One Or The Other

the result of using google as your study aid:

BOOP as in bronchiolitis obliterans with organizing pneumonia

• an inflammation of the bronchioles and surrounding tissue
  
• presents as progressive sob and constitutional symptoms, or simply asymptomatic
• heard as fine crepitations, seen on x ray and ct scan, confirmed on bronchoscopy
  
• causes include: idiopathic, infections, connective tissue disorders (eg sle), drugs (penicillin), transplantation
  
• treatment is usually with prednisolone

BOOP as in betty boop

• depression era cartoon sex symbol
• need i say more?
  

Life Is A Highway

one of my favourite rascal flatt's songs. i know their brand of music is a very diluted version of country music, but i can't help liking their catchy tunes and simple lyrics. check out too God Bless The Broken Road, which imho is one of the most romantic songs ever written.

Life Is A Highway


Life's like a road that you travel on
When there's one day here and the next day gone
Sometimes you bend, sometimes you stand
Sometimes you turn your back to the wind
There's a world outside ev'ry darkened door
Where blues won't haunt you anymore
Where brave are free and lovers soar
Come ride with me to the distant shore
We won't hesitate
To break down the garden gate
There's not much time left today

Chorus:
Life is a highway
I wanna ride it all night long
If you're going my way
I wanna drive it all night long

Through all these cities and all these towns
It's in my blood and it's all around
I love you now like I loved you then
This is the road and these are the hands
From Mozambique to those Memphis nights
The Khyber Pass to Vancouver's lights

Knock me down get back up again
You're in my blood
I'm not a lonely man
There's no load I can't hold
Road so rough this I know
I'll be there when the light comes in
Just tell 'em we're survivors

Bridge:
There was a distance between you and I (between you and I)
A misunderstanding once
But now we look it in the eye

God Bless The Broken Road


I set out on a narrow way many years ago
Hoping I would find true love along the broken road
But I got lost a time or two
Wiped my brow and kept pushing through
I couldn't see how every sign pointed straight to you

Chorus:
Every long lost dream led me to where you are
Others who broke my heart they were like Northern stars
Pointing me on my way into your loving arms
This much I know is true
That God blessed the broken road
That led me straight to you

I think about the years I spent just passing through
I'd like to have the time I lost and give it back to you
But you just smile and take my hand
You've been there you understand
It's all part of a grander plan that is coming true

Discoveries

three discoveries in two days. not big ones, but enough to spice up the holiday. somehow or other, this holiday isn't turning out as fun as the previous break. -sigh-

1) that it -is- quite nice to be sitting along the singapore river having a long dinner talking to your two best friends. the food was good, the company better, but the (main) topic of discussion was the best. mr blue slk, mr supersecret and mr starehardatthexxxfloor. wahaha. just like in the movies, in more ways than one, innit?

2) this article from the bbc about doctors' slang. it is, er, politically incorrect but very true. many apologies to my non-medical readers, but i guess you'll understand that doctors are human after all. anyway, my favourite is "pumpkin positive". short and sweet, and funny. read and enjoy!

3) i had not counted on the wisdom of friends far away from home. i was discussing the finals with someone in the uk and she said, if we knew everything then there's no fun in it, and we wouldn't have to sit for our finals, so we should just hang in there, do our best and learn all that we can, and we'll be fine. that was exactly what i meant by the end we serve, and i'm glad to hear it from someone in the same boat as me. it's the little encouragements from friends like this that keeps one plodding along, and it means much more, since i found out recently that a senior living in london just took his own life not too long ago. you don't understand everything that happens around you, but you simply carry on, right?

one more week left to the hols. i need to make better use of my time!

Phantoms And Dreams

i was going through my facebook profile just now, and i re-read the quote which i put up last year after watching the fantastic royal shakespeare company performance at the esplanade:

"I know now, I understand at last, Konstantin, that for us, whether we write or act, it is not the honour and glory of which I have dreamt that is important, it is the strength to endure. One must know how to bear one's cross, and one must have faith. I believe, and so do not suffer so much, and when I think of my calling I do not fear life."

this line is uttered by nina in the one of the last scenes of anton chekhov's the seagull, when she at last reunites with her former lover treplieff. they both have spent years apart trying to carve out careers - and meaning, in their lives. this is treplieff's reply:

"You have found your way, you know where you are going, but I am still groping in a chaos of phantoms and dreams, not knowing whom and what end I am serving by it all. I do not believe in anything, and I do not know what my calling is."

soon after this he parts with nina, destroys his work and kills himself. it is a tragic ending indeed, and i can't help but think of it as i, more or less, begin my preparation for the final mb. i only have revision postings left after surgery sub-internship if you don't include my psych posting, so this is the last stretch to what i know, or think i know, my calling is. but what end am i serving by it all? last friday's dermatology end of posting test made me feel as if i was groping because nearly half of the test was made up of questions set at mrcp level. am i to berate myself for not knowing the finer points of dermatology? how is having almost half the batch getting lousy posting grades supposed help any of us be better doctors? sometimes i think that the end we serve is our grades, not our future patients and careers.

don't worry, mumbler is fine despite this very emo post. a serious discussion with classmates about the duke vs nus medical schools last night just got me thinking about various stuff. there is much to be done, to be said, to be thought, but in the end, it is the strength to endure that matters. so that i, like nina, can say,

"when I think of my calling I do not fear life."

Weekend Wrap-up

dsc

as expected, it's really a loss of innocence seeing some of the cases. the woman who got syphilis from her husband, but who says he refuses to seek treatment. the young lady who requests for frequent sti checks just so she "knows". and the guy of my age just diagnosed with a chlamydia infection who worries that his children will be deformed by this infection. indeed, we were there to learn not to judge, but i can't help but think there's a common denominator running through these people. what can i say? when asked by the doctor if they would like to undergo screening for hiv and hepatitis, more than one are surprised at the offer. given their sexual history ("friend of friend...and oh two weeks ago it was a karaoke girl") i wonder what the surprise is about. almost all turn it down, waving their hands in the air to dismiss the possibility of getting such diseases. as doctors we can counsel a patient about his dietary, exercise and living habits because they help decrease his risk of cancer and fatal heart disease, but we can't tell a man not to seek a prostitute outside of marriage, or a girl to stay faithful to one partner so that they can never, ever get aids. i recall the hiv patients i met during my infectious diseases posting, and they were obviously shadows of their former selves, living on borrowed time. aids is totally preventable, but it cannot be stopped. isn't it a shame? sometimes i wished we could do more.

of course we saw funny things that i can't blog about, so i'll just end this entry by saying that it is scary how many people have genital herpes which 1) can be transmitted even if the person doesn't have an active lesion and 2) has no cure. the best part is, you can never guess who has it.

mamma mia!

was dragged along to see it with my parents, for "old times' sake". after watching the trailer i thought i couldn't bare to listen to pierce brosnan massacre all the wonderful abba songs, but turns out the movie was much better than i imagined it to be.

for those not acquainted, the movie is based on the successful broadway musical of the same name (which came to singapore a few years back) and is about a girl about to get married but who hasn't got a father to give her away. she finds her mum's diary and learns that there were -three- men in her mother's life when she got pregnant, and so proceeds to invite all three for the wedding. she thinks she will know who the father is (don't ask me why but paternity testing does not feature in this story!) but of course, she does not. in the end, she realises that it does not matter who her father was, and she decides not to get married after all, but to go with her boyfriend to see the world.

my verdict? pierce brosnan absolutely should not be allowed to sing. ever again. when he started singing i didn't know to laugh or to cry. it was just too painful! fortunately there was stellan skarsgard as bill anderson, and the ever reliable dry and wry colin firth as harry "head banger" bright (our last summer was pretty well done i must say) to save the men from being written off.

what a revelation were the actresses. julie walters and christine baranski starred as meryl streep's sidekicks, and what a load of fun they were, fussing and fretting and gyrating as a pair of ex-wild girls should. i was pretty impressed by their rendition of chiquitita - totally loved the harmony! amanda seyfried deserves special mention for bringing spunk and the right amount of girlishness to the character of sophie. plus she's got a fairly good voice too.

but the true star of the show was meryl streep. from start to finish she carried the show with energy and exhuberence that belies a woman of her age (note the air split in dancing queen). and her voice is incredible - i particularly liked her version of winner takes it all which was recorded in just one take. it is little wonder that she's one of the most respected actresses in modern times.

if you have the time, kind reader, here is a 25 minute video of the making of the movie, with snippets of nearly all the songs and cast interviews:



enjoy! i know i did, and it brought back memories of chorale days when we rehearsed again and again for the abba medley. heh.