med school mumblings...

The End

2009-04-27T21:19:00.003+08:00

it's time to move on. mumbler has made her first post on her new blog. time flies doesn't it? saw the army boys coming for their interviews today. i still remember sitting in front of the interviewers and shaking in my seat, and coming out of it thinking i had blown the interview big time.

then it was entering the wards for the first time and being so lost, even asking the ward clerk for cases. before i knew it was electives, and i was having a ball of a time in the grand ol' dame emergency department and at cedars.

finally it was our turn to sit for the final mbbs, and we spent our time mugging and practicing endlessly for short cases, reaching the hospitals early to catch the new cases, traveling around the island to the various hospitals for other cases, and staying up till past midnight to mug for theory. the numerous msn conversations with my online study kakhis (haha, more like distractors!), the routine we quickly developed in that two weeks of study break, and then finally, the big exam itself came upon us.

first it was the horrendously tough theory papers, then it was crazy computer based tests (the usmle is not always better than our exams!!) and later, the final stretch of clinicals which were completely draining.

it's been a long road, and looking at the fresh faces coming for their interviews, i consider how much i have changed in the past five years, and wonder what is in store for me in the next ten to fifteen years of my career and training. only time will tell.

new blog is at http://thefavoureddoc[dot]wordpress[dot]com. please update your links. =)

Shopping

2009-04-24T13:33:00.001+08:00

for phones and mobile lines that is.

because of an email we received a few days ago, suddenly informing us that mohh will not provide any phones or phone lines for our use, we're all in a mad scramble now. the best part? there is no corporate plan available for us. don't you feel the lurve? anyway, mumbler has settled for a $15 plan from singtel that gives free incoming and 100 minutes outgoing. hope that works!

and mumbler has never done this, but she was out last night with her mbbs study group pals, and ended up in a place called house, at dempsey road. she shared this drink called prohibition, which is an alternate take to the long island tea, and it tasted great! it comes with a wedge of lemon and is mixed with coca cola, and besides being delicious, it was also potent. mumbler could only handle two cups (yes you pour the conconction into dainty teacups!) but of course the rest took a lot more. haha.

it was hard not to feel a little sentimental last night. we're moving on now, entering the system with its ridiculous workload and frequent calls, and we all know that it'd be hard to get together as a group again. and to affirm the night's melancholy, they played bucks fizz's "now those days are gone" on the radio. i love the first verse:

Thinking…
Long ago when we were young and free
Love happened easily
And dreams never died,
Life sang a pretty song
Now those days are gone

and while i'm at it, here's another dixie chicks hit (back to the country mood yeah).

Who doesn't know what I'm talking about
Who's never left home, who's never struck out
To find a dream and a life of their own
A place in the clouds, a foundation of stone

Many precede and many will follow
A young girl's dream no longer hollow
It takes the shape of a place out west
But what it holds for her, she hasn't yet guessed

Chorus:
She needs wide open spaces
Room to make her big mistakes
She needs new faces
She knows the high stakes

She travelled this road as a child
Wide eyed and grinning, she never tired
But now she won't be coming back with the rest
If these are life's lessons, she'll take this test

As her folks drive away, her dad yells, "Check the oil!"
Mom stares out the window and says, "I'm leaving my girl"
She says, It didn't seem like that long ago
When she stood there and let her own folks know

good bye med school, hello world.

HOPEX

2009-04-20T20:44:00.002+08:00

mumbler will be doing six months of general medicine at the chalet hospital. she's hoping that she'll be given a chance to do cardio or geri, which is the whole point of choosing a six month posting. the grand ol' dame was her first choice, but it apparently goes to the best of the best (those posted there are like med shens) and since chalet hospital is so near her place, she doesn't really mind.

whatever the case, in this economic situation, she is more than happy to have a job that is secure. the first line of her contract says, "we are pleased to confirm our offer to employ you as a House Officer...on a six year contract term." there are so many articles and interviews in the papers about fresh grads having to lower their pay expectations by a fifth, taking on part time jobs, or not even getting a job interview, so that line is indeed very precious!

and some bimbotic comments: firstly, she loves her mcr no (read in her dialect it is both harmonious and auspicious!) and secondly, she loves the pretty lanyard she bought from montip! now, to find a nice bag and to phase out her wardrobe!

A New Beginning

2009-04-17T23:28:00.002+08:00

it's time for a new blog. =)

more details when i get it up and running. for now, i am still in shock, even though i've looked at my employment letter several times today, especially the part that has the two beautiful letters in front of my name. it's surreal. it's indeed the free favours of God.

ten percent of the class didn't make it. this is the highest in recent memory, so in the midst of the relief and joy of passing, many of us are sad. very sad. we've no idea why it turned out like this. hopefully someone would enlighten us.

meanwhile, here is susan boyle's fantastic rendition of one of my favourite songs from the best musical ever - i dreamed a dream from les miserables. i tear up almost everytime i hear this song. this is where fantine tells her story, of a young happy lass who quickly loses her innocence when her boyfriend leaves her after making her pregnant, and who ends up selling her hair, her teeth, and finally, herself, to raise her daughter. somehow it doens't sound so tragic just reading it like this, but if you read the novel and then listen to the song again, it will be hard not to get emotional. youtube's got the embed disabled, so here's the link and the lyrics below.

I Dreamed A Dream

There was a time when men were kind
When their voices were soft
And their words inviting
There was a time when love was blind
And the world was a song
And the song was exciting
There was a time
Then it all went wrong

I dreamed a dream in time gone by
When hope was high
And life worth living
I dreamed that love would never die
I dreamed that God would be forgiving
Then I was young and unafraid
And dreams were made and used and wasted
There was no ransom to be paid
No song unsung, no wine untasted

But the tigers come at night
With their voices soft as thunder
As they tear your hope apart
And they turn your dream to shame

He slept a summer by my side
He filled my days with endless wonder
He took my childhood in his stride
But he was gone when autumn came

And still I dream he'll come to me
That we will live the years together
But there are dreams that cannot be
And there are storms we cannot weather

I had a dream my life would be
So different from this hell I'm living
So different now from what it seemed
Now life has killed the dream I dreamed.

My Church

2009-04-09T00:25:00.007+08:00

so much has been said, most very negative, so mumbler feels she should post something here to clear up the air. it's not going to be a lengthy discussion because she doesn't have the stamina that other people have, but she hopes it'll clarify some points.

doctrine
preaching about grace does not mean preaching misbehaviour. preaching about grace means getting people to fall in love with Jesus again, and to continually be in love with Him, that we would then follow in His footsteps. preaching the law, on the other hand, means requiring a daily sacrifice to atone for your sins, and means you have to bear with all the curses with not keeping the law - and who can say that he can keep the law perfectly? read the list of curses: it starts from you, to your wife, to your children, and right down to your farm animals. strangely enough, many will continue to preach the law, and many will put their faith in the law (and declare that they'd rather have the "thou shalt nots") despite the fact that Jesus came to give us a new covenant and a better sacrifice!

so essentially, this whole grace versus law issue is the same with having a kid who will emulate the father he loves and looks up to versus another who will follow his father's instructions only because he fears his father's beatings. some might say this is too simplistic an argument, but paul, in his letters to the romans, knew that those who identified their righteousness in the law would insist that the law is the only way in obedience, and hence said,"What shall we say then? Shall we continue in sin that grace may abound? Certainly not!" [rom 6:1-2] so even in the early church grace was a thorny issue, and we shouldn't be surprised that it persists to this day.

church building
new crea currently has a congregation of 18 000 and is growing every year. to give you a sense of how much space we need, here is a breakdown of our logistics every week:

1st service: rock, suntec levels 4 and 6, eng wah cinemas, convention centre gallery west and east
2nd and 3rd serivce: rock, suntec levels 4 and 6, convention centre gallery west and east
4th serivce: rock, suntec levels 4 and 6

this does not include our mandarin and hokkien congregations and children's church, which take up the convention centre ballroom and entire floors of meeting rooms.

as you can probably tell, we're in need of space. i mean, even a place as huge as the indoor stadium (max seating: 11 300) cannot accomodate us, so i think it's a little unfair to criticise the investment in the new building without first offering us a practical solution, no? on a more serious note, the church council and committees spent years sourcing for land and hit snag after snag until this project came about, so it was not a decision made on the spur of the moment.

and just to make it clear, there is never any coercion involved. tithing (and giving in general) has always been encouraged (it came before the law anyway!) and new crea gives out millions every year to local associations, relief efforts and overseas missions. it's been a practice ever since the church was founded - it's just that the amount got bigger. and what's interesting is that on the day we raised the funds (yeah that famous $19mil sunday) there were 4 000 more people in attendance. it's a poorly kept secret that people from other churches (and other countries) also believe in this project with us, so we are truly blessed.

pastor's pay
$500 000 sounds like a lot doesn't it? but i noted something interesting while reading the article in the straits times. trinity christian centre had a turnover of $17mil last year and paid its two directors about $100 000 each. now new crea reported $55mil in income last year and we pay one person $500 grand. it's easy to be distracted by huge, absolute figures, but isn't tcc paying out a greater proportion of their annual income to their leaders? while reading various online forums i also noticed it is often pointed out that pastor kong hee from city harvest draws no pay - but his wife is a hollywood superstar if you remember! (that by itself is a topic for another day, but let me assure my readers out there that my pastor's wife only serves in the ministry and cares for a young daughter and has no "extra curricular activities")

another point i'd like to make is that the straits times conveniently left out the crucial point that new crea is not a public charity, which means that unlike ren ci where they can perform stunts on tv to get donations, we have to rely on something else (and like what pastor says, just focus on getting people to know Jesus). that something else is the weekly offerings which i have mentioned above, and not "donations" as often stated.

i am not agreeing nor defending the pay because firstly views on money are always subjective and secondly, it is difficult for those who have not heard any of pastor's sermons to even understand why so many turn up every week, so attempting to justify it is going to be like trying to explain to a wine noob why anyone would pay thousands of dollars for the best bottle of pinot. but still, let me point out that pastor has given the equivalent of an entire year's salary to the building project since its start in 2007, which means his effective take home pay over the past two years was probably about $250 000?

last words
i'd just like to say that if someone makes a negative comment about new crea, please find out how much he knows about the church. many people are pretty...mindless in such things, simply parroting whatever has been said to them before. because besides the hardcore traditionalists who know everything there is to know about christian theology, most of the comments are made by people who have never stepped into our services or heard tapes of pastor's sermons, so do know where your source is coming from before believing him hook, line and sinker.

incredibly too, there are falsehoods about new crea spread by the elders of some churches, and i know from my conversations with friends and reading personal anecdotes that there is a particular denomination that is extremely averse to new crea. i have been in this church for over 3 years and have never once heard pastor prince criticise any church or pastor. in fact, he has always pointed out that it is not a pastor's job to launch attacks on others while at the pulpit. sadly, it seems that other pastors spend their sundays being distracted and end up behaving like the pharisees of yore - which makes me ask again, so are you sure you want to stick by your "thou shalt nots"?

before i end off, i must also add that the media has a way of blowing things out of proportion, just for the ratings and readership. they choose stories and facts that they know will catch people's attention. you only have to look at how they publicised the deaths of the two young doctors and how the tabloids covered jade goody's last days to understand how they can take nothing and turn it into anything, so please read the reports with a pinch of salt. you can read the read our full press release here.

i hope my post helped to give a different perspective to what has been strewn all over the papers and the internet, and hopefully, this will be the only post i'll need to make!

thank you for reading. ;)

Hiatus

2009-04-05T23:09:00.000+08:00

mumbler's been bumming around the past week, and the days have suddenly slowed down a lot. the wedding was great, and it was an honour to be there, to witness the ceremony presided over by our very own prof who's also a justice of peace. there was movie watching (clint eastwood tackling the issues of life and death in gran torino) and the usual shopping. i really have to watch it, because the weeks of suppressing the urge to spend is now finally being released!

it's a bit strange though, since almost everyone has left to far flung places. london, spain, greece, new zealand...just half an hour ago i was tempted to drop everything and take the first flight out to london. haha. but mumbler is going to a nearby country to visit a friend for a couple of days, then after the results (am keeping fingers crossed!) there's a part two planned. heh.

(yet another cryptic note) and yeah, mumbler's been thinkin'...and wonderin'...hmmm.

It's Over - The Relief

2009-03-30T22:26:00.002+08:00

had a good day's out shopping, walking around orchard road with dad and friends. bought a dress for someone's wedding tomorrow, so i'm feeling pretty relaxed now. will be the mc for the solemnisation, and i hope i don't mess it up!

caught the winter's tale last night. in a way i think it was madness on my part, since it was the last day of mbbs and there i was trying to concentrate and follow a -shakespeare- play. i hadn't read the play before so i spent the first half of act one getting used to the accents and old english, but was later able to sit back and enjoy the performance.

it's an interesting story, essentially about a king who throws his pregnant queen into jail because he suspects she is having an affair and conspiring to take his life. misfortune befalls him after that, as foretold by an oracle, and the king, and the life that he knew, is shattered. years later, he is reunited with the ones that he lost, and the play ends happily. yes, that's the long and short of it, and yes, like all other shakespeare plays, it lasted three hours.

this version was brought in by the singapore reporatory theatre (well done srt!!) and stars ethan hawke and is directed by sam mendes. it's part of "the bridge project" which aims to unite talents on both sides of the atlantic, so it was a bit strange hearing two different accents on stage. act one was more subdued, more "british", but the scenes in act two were festooned with balloons (red, white, blue no less!) and top hats (a la abraham lincoln) and furniture straight out of a western movie. to add to my confusion, they had these minimalist sets that seemed more appropriate for a contemporary play and hence did not help in defining the setting. i did, however, love the idea of having the musicians on stage as part of the cala fare and having those ominous cowbells chime to signal yet another dramatic scene.

what i really -could not- understand was why the audience laughed at some points. i think singaporeans have a weird sense of humour, and i'm not sure where they get it from. the best example i can think of is this scene where the statue of the dead queen comes to life (dont' ask me why!) and the king embraces her. the king has regretted his past actions every day of his life, his "sorrow was too sore laid on, which sixteen winters cannot blow away, so many summers dry", and it is a tender moment as the queen reaches out for his embrace and he feels, for the first time, forgiveness and absolution for his deeds. he exclaims, "o, she's warm!" - and that's when the audience laughed.

for the life of me, i saw nothing funny in that scene, so why the laughter? my poor mbbs bombed out brain can't remember the other examples, but this alone is enough to illustrate my point! wanted to throttle those who laughed. perhaps they were expecting a jack neo type of humour (to be read as "so warm ah?"), where such exclamations are meant to highlight a ridiculous situation or bring out the ignorance of a character without spending much time on character development. whatever the case, it kinda spoilt my enjoyment of the play.

after all my rambling, i must say that i still prefer "the seagull", which was the other srt coup two years ago. the language was easier to understand, the setting less...contradictory, and featuring a cast that appeared more at ease with each other. but i must applaud srt for bringing such fantastic productions to singapore - nothing like learning from the best, yes?

It's Over - The Rant

2009-03-30T11:09:00.003+08:00

a short post just to mark the end of the mbbs. am relieved beyond words. there's much more i want to blog about, but i'm just too tired. all i want to say is, these three weeks must have been some of the most exhausting and tiring times of my (student) life. nothing compares to it. at all. and along the way, it revealed a lot about myself, and about others, both good and bad, and honestly it has changed the way i see things and how i view others. the demands placed on me by the exams and by others really was a wake-up call. it wasn't at all pleasant, so i'm not grateful for it.

maybe i'm just pms-ing, but at the end of it, i knew i had no choice but to redraw the boundaries.

The End Is Near

2009-03-23T22:26:00.003+08:00

very near in fact - just less than a week away.

surgery clinicals were much better than expected - chronic limb ischemia with typical history and well primed patient. shorts were all right too. examiners were pretty nice, and didn't really push. managed to reach management for most, so i take it as a good sign.

after the two weeks of theory horror, i'm glad my surgery experience ended on a high(er) note. was pretty depressed before that, and stressed, because i had two days to pick up the pieces and prepare for saturday. and even though i was complaining before that about being on the first day, i realise now that it has its advantages. the rest of the class was positively trembling after reading our accounts, but we were spared that by going first. plus i got the weekend off, and managed to have a nice dinner at chomp chomp, talking about absolutely non-medical things with a good friend. it felt good haha. not only that, i got pretty excited when my caregroup leader started talking to me about moving on to the young adult ministry, and signing up for genrev camp in september. like, finally!

for now, it's back to the books for medicine. can't wait. plus i'm watching ethan hawke on sunday. woohoo! that's some incentive for me to mug mug mug.

till next time.

Desperado

2009-03-18T21:14:00.002+08:00

you know how when we in primary school and all the "model compositions" used to describe a person pinching himself to wake himself from a bad dream?

i wished i could do that now. i think i speak for my batch when i say it has been the worse two weeks of exams ever, with more carnage to come. misfortune does not come in threes, it comes in sixes. every exam day, we all picked ourselves up while nursing the wounds from the previous day, and marched towards the inevitable outcome.

here's a summary of the written papers:

surgery essays - two on trauma, including one special discussion on trauma in a pregnant patient, one whole question on the entire obstetrics, and one on pid. yes, a surgery paper with NO surgery question.

surgery osse - high level o&g instruments (fetal scalp monitoring and urodynamic transducer anyone?) and a few weird questions.

surgery mcqs - torn between two lovers and feeling like a fool. after cancelling out 3 options, many of us were left with 2 choices, and it was a toss of the coin to decide which option to shade. most of time, we chose wrong.

medicine essays - absence seizures! kawasaki's! dengues! af! NINE marks on the management of absence seizures! go figure.

medicine mcqs - as someone said, tossing a coin had never been more useful in an exam before. i don't think i could have described it any better.

medicine meqs - the jews in the concentration camps were told that they were going for baths - and proceeded to step into the gas chambers. history repeated itself today when we were told at the start "it'd be an easy paper - we don't want to kill you", and then we clicked on the scenarios. mumbler has only seen one status in her life - today she was expected to manage one complicated by anaphylaxis. mumbler has always believed in ruling out life threatening conditions whenever a patient presents - today she was expected to reach a diagnosis after ONE investigation. mumbler has always been taught the standard work up for a man with cough and loss of weight was down the sputum-chest x ray path - today she was introduced to using a BMA to nail a diagnosis of haematogenous TB.

i just think we signed up for the wrong paper. maybe we mistakenly chose "mrcp/mrcs" instead of "mbbs", methinks.

there's no time to waste. surgery clinicals on saturday. the conveyor belt is bringing us closer to the tiger's mouth.

Soon

2009-03-08T20:24:00.003+08:00

the big m starts this week, so mumbler will be taking a break from blogging for a while. then, hopefully, she can move on to a new blog to chronicle her life as a doctor.

for now, it's just cramming for surgery. needless to say, mumbler's miserable. mugging doesn't do very much good to your soul, and reading the seniors' accounts about how they can ask about anything that's humanly possible about the subject just makes your heart sink even lower. at least she had an awesome first service today, and she came out more energised than before. pastor prince is indeed a blessing to many.

so all the best to the medical class of 2009. may we ALL pass the first time round (and save the dean's office and profs the trouble of organising another one in september).

The Joy Of Mugging

2009-03-05T23:16:00.001+08:00

or not. this has got to be one of the most painful periods of my life - the same if not worse than a levels. all that cramming is really turning me into a zombie, this sleep-walking machine that crunches data continuously. it wouldn't have been so bad if the info i studied didn't leak so rapidly, but no sooner do i complete a topic that i forget stuff that i studied previously! argh.

the a level results will be released tomorrow, and each year as i see the joyous rafflesians wave their perfect scores on the news, i recall the day in 2004 when -i- did the same...and put myself on this path, and for which i am now currently mugging for with my life. seems like the cycle will not end anytime soon.

and just when i need like uplifting songs (like josh groban's big hit) i stumble upon a beautiful but very sad song - dreaming with a broken heart, by john mayer. the version i'm listening to is by a college a capella group from the states, and the arrangement is just fabulous. i can't help but listen to it again and again. not that i've got a broken heart - probably quite the opposite actually, but there's something hypnotising about the tune. here's the original.

Revisiting The Past

2009-03-02T21:25:00.007+08:00

not quite, but for some strange reason i went on youtube and searched for "raffles chorale", and out came recordings from their exploits from last year. listening to the polyphonic melodies is oddly comforting and familiar. there's something about the chords, the latin, the -agreement- of the four seemingly different but yet harmonious melodies that brings about a certain peace in my heart. or maybe it reminds me of the hours and hours that i spent in school, remaining standing until the conductor was satisfied with the tuning, pitching, phrasing and whatnots. it was important, you see, for us to perfect the anticipation, the climax, the endings. it wasn't enough just to end a note - it was an art to stop singing but yet leave the last strains of it hanging in the air. it was beauty at its richest but most intangible.

i'm not sure why i'm in such a melancholic and nostalgic mood, and listening to choral music isn't helping at all haha. on top of that, i'm convinced that i have dvt developing from the long hours of sitting at my desk and pouring over my notes. what's sad is that nothing much is going in anymore because i seem to have reached saturation point. bleagh.

and so i leave you with the raffles chorale performing "o magnum mysterium", directed by mr toh ban sheng. this must be the best version i've heard so far, and i recommend listening to it with your eyes closed. just enjoy the music.

oh, i just found out, seems that since we first performed "mate saule" in 2003 for syf, other schools have decided it's pretty trendy to do it. this would be in keeping with the prevailing attitude of the local school choir scene. well, i think our version is still the best. heh. BUT, nothing beats hearing the latvian radio choir singing it. so if by any chance there are jc choir folks reading this blog whose choirs are intending to perform it, please don't use any local choir as your inspiration, use this. listen and be blown away.

Can't Get It Out Of My Head

2009-02-28T15:34:00.002+08:00

my current earworm - and i blame it on The One who has been sending me numerous youtube songs. haha.

and yes, we finally received our online copies of the schedule. many thanks to the dean's office folks who put it up at the eleventh hour, literally! for those outside the wonderful local medicine system, the final mbbs exam is a massive logistical nightmare involving all the hospitals and major departments, spread over slightly over a week (for the clinicals that is).

it's back to the mugging folks.

Rant

2009-02-27T20:17:00.003+08:00

yeah, mumbler is sick. again. fever, sore throat, super drippy nose. i've no idea where i picked it up, but it came on just as i was doing my medicine eopt on wednesday. now it's this gook that is a horrendous tsunami, so much so that i sometimes can't get to the tissue in time, and i think i'm about to od on the anti-histamines in a vain attempt to dry it up.

things that are making matters worse are as follows:

1) studying o&g. just can't stand it. it's all about bleeding bleeding bleeding, plus it brings back traumatic memories from the posting.

2) the fact that we were promised that our exam schedules would reach our mail boxes by today, but in actual fact have not been uploaded to the ivle. someone called up the dean's office and was told 4pm, but well looky looky, it's past dinner time now and nothing's up. in fact, the letters were apparently only sent out -today- so we'll likely get the info earliest on monday. well done. once again it's admin 1 students 0.

3) the tv is out. well, not exactly the telly, but the cable set up box. it's been giving problems since chinese new year, and it's finally given up the ghost. no biggie since i need to study anyway, and especially since american idol has hitherto failed to impress me. lousy singing, poor judging, overly hyped.

there goes my nose again. will blog another time.

When You Believe

2009-02-17T21:45:00.000+08:00

one of my all time favourite songs. and please note that this is the original version that features in the movie which is sung by michelle pfeiffer and sally dworsky, not the ridiculously over sung whitney and mariah one. this version also has a hebrew bridge that is performed by a children's choir, and it never fails to bring a smile to my face listening to it. the entire story can be read here, from moses' first encounter with God to the Passover and finally, the parting of the red sea.

Many nights we've prayed
With no proof anyone could hear
In our hearts a hopeful song
We barely understood
Now we are not afraid
Although we know there's much to fear
We were moving mountains
Long before we ever knew we could

There can be miracles
When you believe
Though hope is frail
It's hard to kill
Who knows what miracles
You can achieve
When you believe
Somehow you will
You will when you believe

In this time of fear
When prayer so often proved in vain
Hope seemed like the summer birds
Too swiftly flown away
Yet now I'm standing here
With heart so full I can't explain
Seeking faith and speaking words
I never thought I'd say

There can be miracles when you believe
Though hope is frail
It's hard to kill
Who knows what miracles
You can achieve
When you believe
Somehow you will
You will when you believe

(Bridge)
A-shi-ra la-do-nai ki ga-oh ga-ah
(I will sing to the Lord, for he has triumphed gloriously)
A-shi-ra la-do-nai ki ga-oh ga-ah
(I will sing to the Lord, for he has triumphed gloriously)
Mi-cha-mo-cha ba-elim adonai
(Who is like You, oh Lord, among the celestial)
Mi-ka-mo-cha ne-dar- ba-ko-desh
(Who is like You, majestic in holiness)
Na-chi-tah v'-chas-d'-cha am zu ga-al-ta
(In Your love, You lead the people You redeemed)
Na-chi-tah v'-chas-d'-cha am zu ga-al-ta
(In Your love, You lead the people You redeemed)
A-shi-ra, a-shi-ra, a-shi-ra
(I will sing, I will sing, I will sing)

There can be miracles
When you believe
Though hope is frail
It's hard to kill
Who knows what miracles
You can achieve
When you believe
Somehow you will
Now you will
You will when you believe
You will when you believe

hang in there people...it'll be over soon enough.

Nutty

2009-02-09T22:06:00.000+08:00

mumbler has left the grand ol' dame behind and is now returning to the palce where she first started her clinicals - western hospital. once again, she's back to needing coffee infusions because she has to wake up early just to be on time. no surprise that mumbler ranked western and the wild wild west hospital last during the recent hopex. haha. am crossing my fingers that i don't get either of those hospitals!

first, mumbler must thank her two fantastic tutors at the grand ol' dame - our dear jedi master from geri and the oscar winning actress from haemato. they must be two of the best tutors i've ever gotten, both funny and knowledgeable at the same time, what more could i have asked for?

but now it's time to revisit psych, which mumbler doesn't.really.like. which is an understatement considering how excited she can be when talking about her favourite specialty (for now lah!). so i'll just grit my teeth and bear with it - after all, these will be the last two weeks of school that mumbler will ever have. for those readers unacquainted, postgrad medicine is the ultimate work and study programme - you work 36 hour shifts and you study at the same time. there really -is- so much to look forward to after graduation, no?

and it seems like i'm in a country mood now - love the music and simple, heartfelt lyrics. this is carrie underwood with "don't forget to remember me".

Eighteen years have come and gone
For momma they flew by
But for me they dragged on and on
We were loadin' up that Chevy
Both tryin' not to cry
Momma kept on talkin'
Puttin' off good-bye
Then she took my hand and said
Baby don't forget

Before you hit the highway
You better stop for gas
And there's a fifty in the ashtray
In case you run short on cash
Here's a map and here's a Bible
If you ever lose your way

Just one more thing before you leave
Don't forget to remember me

This downtown apartment sure makes me miss home
And those bills there on the counter
Keep telling me I'm on my own
And just like every Sunday I call momma up last night
And even when it's not, I tell her everything's alright
Before we hung up I said
Hey momma, don't forget

To tell my baby sister
I'll see her in the fall
And tell mee-maw that I miss her
Yeah, I should give her a call
And make sure you tell Daddy
That I'm still his little girl
Yeah I still feel like I'm where I'm supposed to be
Don't forget to remember me

Tonight I find myself kneeling by my bed to pray
I haven't done this in a while
So I don't know what to say but
Lord I feel so small sometimes in this big old place
Yeah I know there's more important things, but
Don't forget to remember me
Don't forget to remember me

Music And Lyrics

2009-02-05T23:00:00.000+08:00

gotta love this song. it's during times like these that i totally dig country music. this is the dixie chicks with "landslide".

Landslide

I took my love and I took it down
I climbed a mountain and I turned around
And I saw my reflection in the snow covered hills
Well the landslide brought me down

Oh, mirror in the sky
What is love
Can the child within my heart rise above
Can I sail through the changing ocean tides
Can I handle the seasons of my life

Well, I've been afraid of changing cause I built my life around you
But time makes you bolder
Children get older
I'm getting older too
Well...

Well, I've been afraid of changing cause I built my life around you
But time makes you bolder
Children get older
I'm getting older, too
Well I'm getting older too

So, take this love and take it down
Yeah and if you climb a mountain and ya turn around
And if you see my reflection in the snow-covered hills
Well the landslide brought me down
And if you see my reflection in the snow-covered hills
Well maybe
Well maybe
Well maybe the landslide will bring you down

Reality Bites

2009-02-04T21:53:00.001+08:00

tune in to channel 5 tomorrow at 9pm to catch lifewatch, a reality tv show filmed at the singapore general hospital. it would be interesting to watch a show like that - hospital life ain't nothing like er or grey's or house where patients routinely come in disemboweled or holding an arm, or where top of your list of differential diagnoses is the rarest thing on the planet. real life can be stranger than fiction, but it's more mundane than anything, and it's more raw. the last time i caught something like that was many years ago when a tv crew followed a few interns at john hopkins and even managed to film the surgical department's morbidity and mortality (m&m) rounds. whatever it is, mumbler just might appear on the show, albeit in an unglamorous way. haha.

end of posting test is on friday evening, and what i've hearing from those who've taken it is...not very encouraging. most people are usually quite happy to share their stories, but not this time. i just hope it's because the department's trying to scare us, and not because we really are THAT bad. i've been really cramming for it, and hopefully the info can be retained till march 29th.

meanwhile, choosing the hopex postings hasn't been easy, because our batch is the first to be employed directly by the ministry of health. for quite a long time, housemen were employed by either one of the two health care clusters, so no one really knows what to expect with our batch. mumbler can't really decide on her choices, and she's not helped by the fact that they intend to reduce the manpower in some specialties. then again, it all depends on the mbbs grades, so there honestly isn't much use in agonising over it.

lots of things have been happening, some happy and some sad, and involving different groups of people. it's too near the mbbs and i wished that i somehow had the clarity of mind to sort everything out, but i don't. and while the happy stuff easily bring a smile to my face, the sad things make me feel just a bit more cynical and less trusting. not good at all.

on a lighter note, i found this comic from a blog:

A Time To Laugh

2009-02-01T22:25:00.005+08:00

to all the choir/ ex-choir folks out there. i know this article is pretty old, but it cracks me up each time i read it. good for relieving stress. by the way, mumbler is an alto, and i must say, it's a pretty good description. heh.

The Young Person's Guide To The SATB Choir

In any chorus, there are four voice parts: soprano, alto, tenor, and bass. Sometimes these are divided into first and second within each part, prompting endless jokes about first and second basses. There are also various other parts such as baritone, countertenor, contralto, mezzo soprano, etc., but these are mostly used by people who are either soloists, or belong to some excessively hotshot classical a cappella group (this applies especially to countertenors), or are trying to make excuses for not really fitting into any of the regular voice parts, so we will ignore them for now.

Each voice part sings in a different range, and each one has a very different personality. You may ask, "Why should singing different notes make people act differently?", and indeed this is a mysterious question and has not been adequately studied, especially since scientists who study musicians tend to be musicians themselves and have all the peculiar complexes that go with being tenors, french horn players, timpanists, or whatever. However, this is beside the point; the fact remains that the four voice parts can be easily distinguished, and I will now explain how.

THE SOPRANOS are the ones who sing the highest, and because of this they think they rule the world. They have longer hair, fancier jewelry, and swishier skirts than anyone else, and they consider themselves insulted if they are not allowed to go at least to a high F in every movement of any given piece. When they reach the high notes, they hold them for at least half again as long as the composer and/or conductor requires, and then complain that their throats are killing them and that the composer and conductor are sadists. Sopranos have varied attitudes toward the other sections of the chorus, though they consider all of them inferior. Altos are to sopranos rather like second violins to first violins - nice to harmonize with, but not really necessary.

All sopranos have a secret feeling that the altos could drop out and the piece would sound essentially the same, and they don't understand why anybody would sing in that range in the first place - it's so boring. Tenors, on the other hand, can be very nice to have around; besides their flirtation possibilities (it is a well-known fact that sopranos never flirt with basses), sopranos like to sing duets with tenors because all the tenors are doing is working very hard to sing in a low-to-medium soprano range, while the sopranos are up there in the stratosphere showing off. To sopranos, basses are the scum of the earth - they sing too damn loud, are useless to tune to because they're down in that low, low range - and there has to be something wrong with anyone who sings in the F clef, anyway.

THE ALTOS are the salt of the earth - in their opinion, at least. Altos are unassuming people, who would wear jeans to concerts if they were allowed to. Altos are in a unique position in the chorus in that they are unable to complain about having to sing either very high or very low, and they know that all the other sections think their parts are pitifully easy. But the altos know otherwise. They know that while the sopranos are screeching away on a high A, they are being forced to sing elaborate passages full of sharps and flats and tricks of rhythm, and nobody is noticing because the sopranos are singing too loud (and the basses usually are too). Altos get a deep, secret pleasure out of conspiring together to tune the sopranos flat.

Altos have an innate distrust of tenors, because the tenors sing in almost the same range and think they sound better. They like the basses, and enjoy singing duets with them - the basses just sound like a rumble anyway, and it's the only time the altos can really be heard. Altos' other complaint is that there are always too many of them and so they never get to sing really loud.

THE TENORS are spoiled. That's all there is to it. For one thing, there are never enough of them, and choir directors would rather sell their souls than let a halfway decent tenor quit, while they're always ready to unload a few altos at half price. And then, for some reason, the few tenors there are are always really good - it's one of those annoying facts of life.. So it's no wonder that tenors always get swollen heads - after all, who else can make sopranos swoon? The one thing that can make tenors insecure is the accusation (usually by the basses) that anyone singing that high couldn't possibly be a real man.. In their usual perverse fashion, the tenors never acknowledge this, but just complain louder about the composer being a sadist and making them sing so damn high.

Tenors have a love-hate relationship with the conductor, too, because the conductor is always telling them to sing louder because there are so few of them. No conductor in recorded history has ever asked for less tenor in a forte passage. Tenors feel threatened in some way by all the other sections - the sopranos because they can hit those incredibly high notes; the altos because they have no trouble singing the notes the tenors kill themselves for; and the basses because, although they can't sing anything above an E, they sing it loud enough to drown the tenors out. Of course, the tenors would rather die than admit any of this. It is a little-known fact that tenors move their eyebrows more than anyone else while singing.

THE BASSES sing the lowest of anybody. This basically explains everything. They are solid, dependable people, and have more facial hair than anybody else. The basses feel perpetually unappreciated, but they have a deep conviction that they are actually the most important part (a view endorsed by musicologists, but certainly not by sopranos or tenors), despite the fact that they have the most boring part of anybody and often sing the same note (or in endless fifths) for an entire page. They compensate for this by singing as loudly as they can get away with - most basses are tuba players at heart. Basses are the only section that can regularly complain about how low their part is, and they make horrible faces when trying to hit very low notes.

Basses are charitable people, but their charity does not extend so far as tenors, whom they consider effete poseurs. Basses hate tuning the tenors more than almost anything else. Basses like altos - except when they have duets and the altos get the good part. As for the sopranos, they are simply in an alternate universe which the basses don't understand at all. They can't imagine why anybody would ever want to sing that high and sound that bad when they make mistakes. When a bass makes a mistake, the other three parts will cover him, and he can continue on his merry way, knowing that sometime, somehow, he will end up at the root of the chord.

**

how i miss choir and the choir folks!

The Day The Music Died

2009-01-27T20:15:00.004+08:00

a legendary song, about music legends. they don't write songs like this anymore! here is the original by don mclean:

American Pie

A long, long time ago...
I can still remember
How that music used to make me smile.
And I knew if I had my chance
That I could make those people dance
And, maybe, theyd be happy for a while.

But february made me shiver
With every paper I'd deliver.
Bad news on the doorstep;
I couldn't take one more step.

I can't remember if I cried
When I read about his widowed bride,
But something touched me deep inside
The day the music died.

Chorus:
So bye-bye, miss american pie.
Drove my chevy to the levee,
But the levee was dry.
And them good old boys were drinkin whiskey and rye
Singin, this'll be the day that I die.
This'll be the day that I die.

Did you write the book of love,
And do you have faith in God above,
If the Bible tells you so?
Do you believe in rock n roll,
Can music save your mortal soul,
And can you teach me how to dance real slow?

Well, I know that you're in love with him
`cause I saw you dancin in the gym.
You both kicked off your shoes.
Man, I dig those rhythm and blues.

I was a lonely teenage broncin buck
With a pink carnation and a pickup truck,
But I knew I was out of luck
The day the music died.
I started singin,

Chorus

Now for ten years weve been on our own
And moss grows fat on a rollin stone,
But thats not how it used to be.
When the jester sang for the king and queen,
In a coat he borrowed from james dean
And a voice that came from you and me,

Oh, and while the king was looking down,
The jester stole his thorny crown.
The courtroom was adjourned;
No verdict was returned.
And while lennon read a book of marx,
The quartet practiced in the park,
And we sang dirges in the dark
The day the music died.
We were singing,

Chorus

Helter skelter in a summer swelter.
The birds flew off with a fallout shelter,
Eight miles high and falling fast.
It landed foul on the grass.
The players tried for a forward pass,
With the jester on the sidelines in a cast.

Now the half-time air was sweet perfume
While the sergeants played a marching tune.
We all got up to dance,
Oh, but we never got the chance!
`cause the players tried to take the field;
The marching band refused to yield.
Do you recall what was revealed
The day the music died?
We started singing,

Chorus

Oh, and there we were all in one place,
A generation lost in space
With no time left to start again.
So come on: jack be nimble, jack be quick!
Jack flash sat on a candlestick
Cause fire is the devils only friend.

Oh, and as I watched him on the stage
My hands were clenched in fists of rage.
No angel born in hell
Could break that satans spell.
And as the flames climbed high into the night
To light the sacrificial rite,
I saw satan laughing with delight
The day the music died

He was singing,
Chorus

I met a girl who sang the blues
And I asked her for some happy news,
But she just smiled and turned away.
I went down to the sacred store
Where I'd heard the music years before,
But the man there said the music wouldn't play.

And in the streets: the children screamed,
The lovers cried, and the poets dreamed.
But not a word was spoken;
The church bells all were broken.
And the three men I admire most:
The father, son, and the holy ghost,
They caught the last train for the coast
The day the music died.
And they were singing,

Chorus

They were singing,
Bye-bye, miss american pie.
Drove my chevy to the levee,
But the levee was dry.
Them good old boys were drinkin whiskey and rye
Singin, this'll be the day that I die

Firecrackers

2009-01-25T13:26:00.001+08:00

this is the song that mumbler woke up with today. not sure how it popped into my consciousness, but it's one of my favourite disney songs from one of my most loved disney cartoons.

here it is, as sung by danny osmond:

as a side note, mumbler wants to use the words whatever, fed up, tired...all in one sentence. but there are so many things to enjoy, so she's not about to lose her peace just because others lose theirs readily.

新年快乐 everyone. heh.

Random Thoughts

2009-01-20T22:05:00.002+08:00

mumbler has been really busy at the grand ol' dame. lots of cases, and other exciting non-medical stuff too. saw my first kartegener's and symptomatic myasthenia gravis ("can you all stoop down, my eyes are tired from looking up at you"), and heard a whole lot of murmurs. heh.

what else?

a dear friend's got some recent good news, so i'm extremely happy for her.
haven't really laid out grad trip plans - which probably doesn't matter that much since i want to travel within this region anyway, but the idea that nothing is planned is really bugging me.
received my employment package today - will have to change my plans re:postings because they've changed the format, and i'm very puzzled as to why they're asking me for my 'o' level results and class of driving licence. what has that got to do with being a doctor?
am a bit disappointed with what i've seen recently. i mean, isn't it not right to try and examine a patient who's in quite a lot of discomfort and pain even though the patient is a "good case"? there's more stuff i could blog about, but this being a public blog, i shall stop here. you never know who might pounce on your words and blow it up. think forum page letter, school admins, minister of state. there was a time when i might have been more actively involved in discussions, but at this point of my life, i'd like to be left alone, thank you very much. to qualify myself, it doesn't happen very often, so don't quote me.
doesn't it make your blood boil when you see things like this? a girl is married off at ten to repay a debt her father owed and it's wrong and unfair to think she's too young? and does the judge honestly think that the middle age man will stand by his pledge to not have sex with her till she reaches puberty? the whole pledge thing is such a joke. a man his age should be adopting the girl, not marrying her! it's very sad to see things like this, because a woman's life is worth so much more than what these men deem it to be.

that's all for now. chinese new year is coming up! yay! food, food and more food. i'll try not to get sick this time. haha.

Here And Now

2009-01-13T20:33:00.000+08:00

mumbler is in the middle of her revision posting, and it's been quite all right so far. great tutors, great range of cases, and great hospital. somehow the grand ol' dame doesn't give me weird vibes like the western hospital does. no matter how tired i am in grand ol' dame, i never quite reach the fatigue and malaise i felt during surgery, where i wished nearly every day that caffeine came in an intravenous form. the guys are back to their cheeky, singing selves and i'm feeling more relaxed than i thought i would at this stage, isn't that great?

it was a lazy day today, first a lecture then a tutorial postponed. munched on the great houseman's corner chocolate waffle in between seeing great cardio cases. if the mbbs weren't two months away, i would have proclaimed that this is THE life. haha.

in fact, mumbler was so relaxed today, she found videos of tina fey, the first is her acceptance speech at the golden globes on sunday, and the other a clip of the best of liz lemmon, enjoy.

Tina Fey

2009-01-03T23:02:00.002+08:00

one word - awesome. i wished i knew about her before sarah palin bumbled into the news. she writes, acts, produces. best of all, she's funny. like, snl funny. how cool is that?

this is the commercial she did for amex. hilarious!

(yesterday was mumbler's day of favour. more to come i'm sure, but i'll blog about it soon enough. and there's more than one reason why yesterday's events will occupy a special place in my memory.)

The Dektos Year Ahead

2008-12-31T22:01:00.000+08:00

the year threatened to end in a lousy way, but as always, things turn around. and despite nursing a secondary bacteria infection, mumbler managed to enjoy herself during the break - youth xmas bash, combined service, jc class gathering, dinner at timbre with close friends, the yearly walk down orchard road with family to see the lights...i might have certainly eaten and enjoyed myself more if not for the flu, but i'm not complaining. my top priority was to catch up on the hours of sleep lost during surgery posting - and i managed to that with the help of zyrtec and cough syrups. haha.

the new posting has started off on a good note - good tutors, and patients aplenty at the grand ol' dame. hope to get some proper grilling and practice this time round since the big exam is less than ten weeks away!

for now, a very happy new year to everyone! and yes, it'll be the dektos year (see here; dektos (gr) accepted, favoured) so get excited!

What Sweeter Music

2008-12-16T21:01:00.007+08:00

yes, instead of preparing for her surgery end of posting test, mumbler is surfing youtube - and she found a video to her favourite (modern) christmas carol of all, what sweeter music, written by the amazing john rutter. listening to it brings back memories of choir, of hawaii, of carefree days long gone.

(based on the poem by robert herrick)

What sweeter music can we bring,
than a carol for to sing
The birth of this our heavenly King ?
Awake the voice! awake the string !

Dark and dull night, fly hence away
And give the honor to this day
That sees December turned to May.

Why does the chilling winter's morn
Smile like a field beset with corn ?
Or smell like to a meadow newly shorn
Thus, on the sudden ?

Come and see
The cause, why things thus fragrant be:
'Tis he is born, whose quickening birth
Gives life and luster, public mirth,
To heaven and the under-earth.

We see him come, and know him ours,
Who with his sunshine and his showers,
Turns all the patient ground to flowers.

The darling of the world is come,
And fit it is we find a room
To welcome him.

The nobler part
Of all the house here is the heart,

Which we will give him; and bequeath
This holly and this ivy wreath,
To do him honour; who's our King
And Lord of all this revelling.

Bushed

2008-12-13T21:09:00.000+08:00

mumbler is hacking away from the silly cold that always comes with the northeast monsoon. stopped the post nasal drip with clarinase (since piriton will put me to sleep) and now trying to stop the cough with dextrometophan, which retails for $1.60 for 20 tabs at the neighbourhood pharmacy. ever since she learnt pharmacology in second year and found out how affordable (read:real cheap!) the drugs are at pharmacies, she's self-medicated, and saved a heck a lot of money and trouble. it's pretty ironic, but what can one do when gps are prescribing klacid for the common cold?!

the long hours at the hospital have not helped. and yes, mumbler has just reached home after a marathon day of lectures, with neurology in the morning, followed by ecgs, haematology and medicine osce lectures in the afternoon, held in two different places. the last time my brain throbbed like that was when i downed two maguaritas too rapidly last year. sigh. i need more hours to rest, but the days just pass so quickly. we're down to 80+ days to the big day now. argh!

but amidst all that, listening to the story of the patient presented at today's neurology lecture reminded me what medicine is all about. 50+ year old man with a 10 year history of parkinson's. initially presented with reduced arm swing, started on dopamine agonists, switched to l-dopa, and to date has 2 admissions for psychosis and attempted suicide and 1 for pneumonia requiring an icu stay. wife's a schoolteacher, and worries that he'll fall if he goes out. as our tutor said, in most cases the caregiver starts out wishing for complete recovery. but as the disease progresses, the caregiver ironically wishes for reduced control, so that the risks of injuries to the patient are less.

it's a sad state of things, which begs a discussion on the topic of euthanasia. lots of publicity especially since uk television has just aired a documentary showing a man die after receiving a lethal dose of medication. so much has been said about giving patients a dignified death, and even having seen the state some patients are in the hospital, i can't bring myself to believe that it's a doctor's duty to help a patient die. because doctors are meant to battle death and disease, not aid them. because terminal illnesses rob patients and their families of hope, which is the one thing that makes life meaningful, and doctors are meant to give hope. in short, because it's wrong. it'll be a sad day for singapore if we allow active euthanasia. i hope it never happens.

Blackbird/ I Will

2008-12-08T23:05:00.002+08:00

i can't help it, it's just too beautiful a song. managed to find a filipino group singing it in rehearsal. a bit too fast for my liking and the conductor interrupts them at the end, but it's the same lovely 8-part arrangement i had the chance to perform last year. until i find a way to put up the original version, this has to do. heh.

Blackbird/I Will - arr Swingle Singers

Blackbird singing in the dead of night
Take this broken wings and learn to fly
All your life
You were only waiting for this moment to arise

Who knows how long I've loved you
You know I love you still
Will I wait a lonely lifetime?
If you want me to I will

And if I ever saw you
I didn't catch your name
But it never really mattered
I will always feel the same

Love you forever and forever
Love you with all my heart
Love you whenever we're together
Love you when we're apart

When at least I find you
Your song would fill the air
Sing it loud so I can hear you
Make it easy to be near you
For the things you do endear you to me
You know I will

Blackbird singing in the dead of night
Take this broken wings and learn to fly
All your life
You were only waiting for this moment to arise

Blackbird singing in the dead of night
Take this sunken eyes and learn to see
All your life
You were only waiting for this moment to be free

Blackbird fly, blackbird fly
Into the light of the dark black night

Time Out

2008-12-08T15:16:00.001+08:00

it's mid way through the revision posting and it's cram cram cram non stop so far. so much to know, so much to read, and so much to practise. one senior staff sent chills down my spine when he said to the three groups at the western hospital now, "you mean you guys don't know this at all?" mumbler knows she's supposed to pull up her socks and carry on with the race, but currently she's trying to hold up her socks while running, so it isn't easy.

meanwhile, there's talk about grad trip (which mumbler still hasn't confirmed yet) and plans for the christmas holidays. get togethers with old friends and jc class, and hopefully some caroling as well. a quick breather before the madness starts again in medicine revision posting.

met up with two seniors after service yesterday, and how aptly so. much encouragement and strength was received - and a reminder on what being a receiver means. let me now leave you with the opening song from yesterday's praise and worship. it was nice to be back serving in the rock once again!

For All You've Done

the swingle singers version of blackbird/i will is my current earworm. too bad that youtube does not have a video of it. what i would give to be able to perform that song again!

100 Days

2008-11-30T18:59:00.000+08:00

it's 100 days to the big exam, and very appropriately, this song was performed at the end of today's service, sung beautifully by angie.

Jesus Take The Wheel

She was driving last Friday on her way to Cincinnati
On a snow white Christmas Eve
Going home to see her Mama and her Daddy with the baby in the backseat
Fifty miles to go and she was running low on faith and gasoline

It'd been a long hard year
She had a lot on her mind and she didn't pay attention
she was going way too fast
Before she knew it she was spinning on a thin black sheet of glass
She saw both their lives flash before her eyes
She didn't even have time to cry

She was so scared
She threw her hands up in the air

Jesus take the wheel
Take it from my hands
Cause I can't do this on my own
I'm letting go
So give me one more chance
To save me from this road I'm on
Jesus take the wheel

It was still getting colder when she made it to the shoulder
And the car came to a stop
She cried when she saw that baby in the backseat sleeping like a rock
And for the first time in a long time
She bowed her head to pray
She said I'm sorry for the way
I've been living my life
I know I've got to change
So from now on tonight

Jesus take the wheel
Take it from my hands
Cause I can't do this on my own
I'm letting go
So give me one more chance
To save me from this road I'm on
Jesus take the wheel

Oh I'm letting go
So give me one more chance
Save me from this road I'm on
From this road I'm on
Jesus take the wheel
Oh take it take it from me
Oh

RIP

2008-11-24T21:21:00.002+08:00

just received news that another of the patients we cared for in haematology passed away last night. he was 24.

there was a time when palliative medicine appealed to me. now i have my doubts.

My Two Cents' Worth

2008-11-22T22:59:00.003+08:00

mumbler would just like to say that some people need to wake up, grow up, and give up being so self - centered and childish. also, to learn when to shut up, and to have the b-s to deal with things head on. even women don't whine and b-h so much.

and this is the current song in my head now. very appropriate given the angst and cynicism built up over the past one month.

There's A Fine, Fine Line

There's a fine, fine line between a lover and a friend;
There's a fine, fine line between reality and pretend;
And you never know 'til you reach the top if it was worth the uphill climb.
There's a fine, fine line between love
And a waste of time.

There's a fine, fine line between a fairy tale and a lie;
And there's a fine, fine line between "You're wonderful" and "Goodbye."
I guess if someone doesn't love you back it isn't such a crime,
But there's a fine, fine line between love
And a waste of your time.

And I don't have the time to waste on you anymore.
I don't think that you even know what you're looking for.
For my own sanity, I've got to close the door
And walk away...
Oh...

There's a fine, fine line between together and not
And there's a fine, fine line between what you wanted and what you got.
You gotta go after the things you want while you're still in your prime...
There's a fine, fine line between love
And a waste of time.

ps apologies, this is the best video of the song i can get on youtube.

and it was great to meet up with a good friend for (second) lunch today. all by coincidence, all in good time, and to think i was tempted to skip this morning's tutorial to catch some sleep. sometimes it's great to be led like this, because the day always ends up much better than you anticipated.

Before I Move On

2008-11-21T23:04:00.001+08:00

sip has been an interesting experience. the people, the lack of responsibility on my part in terms of making clinical decisions, the patients...these factors and more have made the 2 months seem more like a muted holiday rather than part of the curriculum. my most recent team had the most varied personalities, including a female mot who's very jovial and a reg who cracks the most whacky jokes (with a straight face i must add) whenever he is tired. we have this silent communication language with our eyes, and some of us have er...a common trigger for laughter, which today would have spelt disaster for me if i hadn't managed to run off in time. i think the other doctors around me must have been wondering why i was in stitches while aurora-ing an lft. haha.

the down side of sip is of course finding out who's what and who's not amongst your batchmates. the reality of working (hospital) world is introduced to us, and it's disappointing to see how some people have reacted to it. i guess it's unavoidable right? i'll just have to learn to work with people like that.

and to add to my cryptic comment (which might not be so cryptic after all): witnessing first hand how easily a guy can loose himself of emotional attachment to a specific person overnight is scary. always knew that men are better at such things than women (duh) so i shouldn't have been surprised, but seeing the change made my head spin for a bit. mumbler is rather unscathed (not completely, despite being detached from the situation) so don't worry, but in summary, men are -cryptic-. and that doesn't change with age and marital status. haha.

To Comfort Always

2008-11-17T22:24:00.002+08:00

click here for photos that speak a thousand words. and to think that xdr-tb is getting increasingly rampant as aids spreads. view the website here.

What A Difference A Week Makes

2008-11-16T10:13:00.002+08:00

mumbler moved to the hepato-biliary team this week, and her work has correspondingly increased. more cases, more discharges, and more walking. the team is quite big but at least everyone seems to work well together. one thing bad about being a big team though is that we silly sips have had a hard time trying to order drinks for team breakfast the past week. almost every day the orders are wrong because there are so many combination of drinks - kopi bing, kopi bing siew dai, tea c, tea ping etc etc. quite a mess we've made...but fortunately no con/reg has realised it. haha.

there has been some moving and shaking in this sip, and mumbler has been slightly upset by it. perhaps she was spoiled by her time at grand ol' dame haemato, but honestly, what she has witnessed here has made her angry, and wanting to get out of this posting asap/stat/pronto. all she can say here is that sometimes, people should think carefully before they complain, because some unpleasant things have been repeated back to me by seniors outside of central hospital, from other departments. some are even generalisations and i don't appreciate that at all. no names were dropped so far, but i'm aware of the incidents that gave rise to the complaints, which of course i'm not at liberty to discuss on this blog. so think, people, think. ours is a small community and there's no point souring relations like this.

it's been a roller coster week so far, let's hope my last week in surg sip will be quieter.

i really can't wait for it to be over.

Some Things...

2008-11-11T23:14:00.002+08:00

...About Ward Work
check out this letter to the online forum. in summary, the writer is expressing her dissatisfaction of at receiving lousy service from local doctors, compared to those overseas. read also the comments made by the readers. it's not the first such letter, and it'll definitely not be the last. am too tired to blog properly but here are some thoughts:

1) medicine is really more of a service industry nowadays, rather than a noble profession.

2) people often demand too much, and this has nothing to do with respect to how much they pay to stay in the hospital. by "too much" i mean expecting the doctor/ team in charge to give their absolute attention, or for an instant diagnosis (after one x ray and one blood test) or for us to promise no complications during a procedure. doctors are humans, we need to spend time with the numerous patients that pass through the doors of a restructured hospital, we need time to investigate (however heard of a murder that was solved in a day?!) and only God can promise you "no complications".

many apologies if this sounds a bit harsh, but mumbler spent nearly two hours during exit rounds today dealing with something like these, so she is in a cynical mood. more accurately, it was the reg who did all the talking (hats off to him man, he was so composed throughout) and the two cases were very different, but by the time the rounds ended and our changes were settled, i was starting to question my ability to cope with such things for the rest of my career and wonder how much of medicine is treating people's anxieties/egos/misconceptions as opposed to curing illnesses.

...About People
mumbler is disappointed with some people. she saw it coming, but nothing quite prepares you for it. it seemed funny when parodied in our playhouse segment (that's for another post) but isn't so funny when it really happens.

cryptic thought: there are some things a girl knows, and can only keep to herself. what she can only do after that is to shrug it off and move on.

Scattered Thoughts

2008-11-03T22:13:00.001+08:00

mumbler is quarter way through her surgical sip at the central hospital. everyone's nice and all, but having nothing much to do in between morning and exit rounds really drains me. and the waiting for the exit rounds. i was kindly let off by my ho this evening, because the exits were still not happening even after six. and considering that we're so close to the final m, such wandering around isn't very reassuring!

since we're on the topic, mumbler wants to whine about the silly iv cannulas that central hospital uses. the cannulas are weird, so much so that i can't use one hand to remove the stylet. what happens is that i need two hands to pull out the stylet while sliding in the cannula, but when i do that i let go of the skin, which results in the vein recoiling, and i go through and through. argh!! i know my plug setting can't be that bad, since i still can take blood fairly easily, so it must be the cannula right? right?!

i had my one and only surgical call last friday. continuous rounds of blood takings with the r1 kidnapping me for dinner and blue letter referrals. surprisingly i wasn't sleepy at all and was quite awake even at three in the morning. in contrast, my eyes were barely open and my mind all wooly by midnight when i was on active call at the grand ol' dame. must be something about the kopi at kopitiam. heh. slept for less than an hour, but was grateful that the room wasn't too cold, unlike the one i had during medicine posting, which had a maddeningly cold aircon that directed icy wind to my lower limbs and prevented me from sleeping soundly.

my call ended off well, but it didn't start out very promisingly. first, during pre-rounds, mumbler was yelled at by a nurse for taking the files. i mean, how exactly does she expect any doctor to pre-round without taking the files? if i were a dashing young house officer or a much senior doctor, i doubt she'd dare open her mouth. she, of course, is one of the black sheep, as they say. during the night call i even had nurses preparing the stuff for iv cannulation, who were encouraging and friendly, and who made my call a breeze really, so i'm very grateful for nurses i've met so far. just not her. haha.

and well, guess whose file i was taking a look at? a known case of ca colon, with mets everywhere. fell the night before, fractured his skull and began to bleed into his stoma. by morning rounds he had already lost nearly 2L of blood through the stoma. alert, he was complaining about his back pain, telling us we should ask his wife since she knew his condition well. his wife was in tears as the consultant explained that palliation was our goal, no longer curative, and she uttered the most heart wrenching question i've ever heard in my 3 years of clincals, "how much time will he leave me with?"

he died three hours later.

Last Holiday

2008-10-27T23:47:00.003+08:00

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

2008-10-23T22:03:00.000+08:00

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

2008-10-19T23:49:00.003+08:00

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

2008-10-17T21:31:00.001+08:00

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

2008-10-14T23:57:00.000+08:00

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

2008-10-05T23:41:00.002+08:00

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.

Bumper Weekend

2008-09-28T23:24:00.003+08:00

finally, mumbler got the weekend she's been waiting for. after many false starts the past few weeks, she finally had back to back action this time round.

friday: chill out time for the nus cluster at munchie monkeys. great fellowship and fantastic praise and worship. can't say the same for the food though.

saturday: whole day family day, with a bit of swimming thrown in.

sunday: combined service where the first part of the preaching was enough to feed on. long lunch at tampines with dear z-, before heading to great world city to watch wall-e finally. rushed back just in time to watch the f1 race, and to see massa attempt to refill and drive at the same time. heh.

i also had the honour of watching paul anka in concert on monday. even though i knew i'd be busy, i was quite keen to go because how often do you get a chance to see the man who wrote "my way" perform live? it's not hard to be awe as you watch the guy who worked with buddy holly, who wrote songs for tom jones and frank sinatra, who has had an amazing fifty year career, sing and charm the crowd with a medley of familiar tunes. i don't think he'll come back to singapore anytime soon (paul newman passed away on friday; needless to say my mom was heartbroken), so i'm glad i got the chance.

a review of wall-e will be up when i've the time this week. meanwhile i leave with you one of my favourite scenes from the bbc's 1995 adaptation of p&p (which is the version to watch by the way, not the silly, hyped up, completely un-austen, historically inaccurate and wuthering heights-like keira knightley-matthew mcfadden one!!). this is where darcy (colin firth) proposes to elizabeth (jennifer ehle). she rejects him, and he reels, not just from the rejection, but also from the reasons for lizzy's refusal. it is a turning point in their relationship, as lizzy later finds out that her accusations were based on biased opinions, and darcy learns "how insufficient were all my pretensions to please a woman worthy of being pleased."

don't you just love jane austen?

Mutterings

2008-09-16T22:42:00.000+08:00

some random thoughts again, where mumbler:

suddenly wishes we were all spineless so that she needn't mug so much for ortho
is happy to have spend her birthday week with her friends and family, and eating lots of delicious cakes
is shocked at the turn of events on wall street
would like nothing more than to drop her books and take the next flight out to join her friend in the lake district
knows she hasn't been in a talkative mood lately but still wants to sing like she did last year at the young musician's society (yms)
is frankly quite disgusted at the accounts she's been hearing about the difference between her medical school and the new kid on the block, duke, because if these stories are true, then all she can say is, it's all about the money baby - and it's too bad we're the ones who aren't paying
needs more sleep!

that's all for now. will blog again when thoughts are more coherent.

Some Thoughts

2008-09-09T23:48:00.001+08:00

right now on our class yahoo groups, is a discussion regarding an american board exam that the admin is suggesting we take. lots of interesting points of view, and it seems like those wanting to take the exam are in the minority. which is good, in mumbler's opinion, because no one likes to take exams, even if they're free. and to sit for a totally different sort of exam (no matter how the admin tries to tweak the questions it'll still have a taste of american right?) a few weeks before the final mb is pure madness. after, maybe, but definitely not before. i really doubt any mot would readily sign up for a usmle step 3 just before sitting for his mrcp! am hoping nothing happens because otherwise, mumbler will be tearing her hair out by the time march comes.

coincidentally in the papers lately, several letters have been written about the intake of medical students. year in and year out, various parents have commented on how 'heng' they've been to have the money to send their kids overseas because the our school apparently denies entry to some of the 'best' students (ie their own kids). i shan't comment on it since my opinion is obviously going to be biased since i'm in the system, plus the fact that my parents could never have afforded to pay for my medical education overseas, but i'll just say that when it comes to starting work as a house officer, it really doesn't matter which school you come from. what matters is that you can work fast and work smart, something which i hope to learn.

but what i wanted to comment on was this letter published today, in which the writer asked that since the ministry says we're short of doctors, why don't we have more places in nus? i should think that the answer is simple - a lack of resources. our lecture halls are full (the latest batch is 260 strong!), the wards are cramped with medical students, and some of our labs have been closed. just today our id tutor wanted us to clerk a patient, but he vehemently rejected us, because the duke students had gotten to him first (and it seems that they clerk alone, so imagine how many people have talked to him already). more locally-trained doctors is always a good thing (knowledge of local health system, dialects, diseases, etc) but until the financial and logistical constraints can be dealt with, it is unlikely that the class size will increase much more.

and talking about admin, sometimes, some of them really get my goat. yesterday a few of us received text messages threatening us with something if a specific paperwork wasn't done. again, mumbler regrets that this blog is too public, because this bit of paperwork has nothing to do with us, yet we are being held responsible for it, so preferably, mumbler would like to insert a rant about idiotic admin staff here. but i must say, in case i get shot down, that there are excellent admin staff that have helped me and my classmates inmeasureably and i concede they don't get much thanks from us. oh well.

and my frivolity was extended by one day today. haha.

For Now

2008-09-07T23:50:00.000+08:00

while mumbler is in her avenue q craze, here's a snippet from the opening scene:

A Backward Glance

2008-08-31T22:08:00.003+08:00

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?

Joy to The World

2008-08-28T22:04:00.001+08:00

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.

Anew

2008-08-26T21:32:00.002+08:00

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.

Chill Out

2008-08-24T20:22:00.004+08:00

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

Fleeting Thoughts

2008-08-22T21:40:00.000+08:00

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.

Midway And A Crisis

2008-08-20T22:01:00.001+08:00

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.)

Flashback

2008-08-14T21:53:00.000+08:00

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.

Squeezing It All In

2008-08-11T19:39:00.003+08:00

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?

So You Had A Bad Day

2008-08-08T16:22:00.002+08:00

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.

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

2008-08-07T22:15:00.003+08:00

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.

The Next Level

2008-08-04T21:02:00.004+08:00

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.

In Summary - The Signs

2008-08-03T21:18:00.016+08:00

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.

In Summary - New York New York!

2008-07-30T22:41:00.000+08:00

oh the city that i dreamt so long of visiting but fate dealt a cruel blow - i fell sick. haha. yesh, a most horrendous cold which had to get worse before it got better, so i spent a good part of my time in new york sneezing and sucking on cough drops bought from the trusty cvs pharmacy.

nonetheless, new york was as exciting as everyone describes it to be, and i wished i had more time there. i didn't see the statue of liberty because the tickets were sold out! but i did manage to visit other famous new york attractions. heh.

grand central station
the stuff of folklore and romanticised by turn of the century american authors like edith wharton, grand central station (more correctly, grand central terminal) serves several lines linking new york city to other parts of the state and neighbouring connecticut. there are about 50 platforms in all and it's been operating for over a century. walking in, one is struck speechless by the grandeur of the place, the high ceiling with the star spangled banner, and simply the feeling of just being there. it's a reminder of the old money of new york, and one can imagine the upper crust of society in the 1900s mingling at the station.

united nations
the united nations building is pretty nondescript and is situated between east 4nd to 48th street. the only way to get in is to follow the tours that leave every hour or so. you are taken through the various assembly halls and lots of gifts from various nations. lots of historical facts are thrown your way, and there are exhibits about aids, land mines and other political-worthy stuff. and how can the visit be complete if you don't have a peek inside the general assembly?

security was tight everywhere, and they've got a tent where all visitors must pass through. they don't allow phototaking inside, but i was very tempted to ask for an exception because it was there that i saw the most bored looking dog ever. he was one of those k9 dogs but his handler wasn't interested in moving around. and in the new york heat, that was probably too much for the dog to bear, so he sank to his paws and barely kept even one eye open. heh.

wall streetah hah. the place where fortunes are made and lost, where people turn millionaires overnight, where the american dream begins. you can't go into the nyse(above) anymore, so the best you can do is to stand outside and imagine being on the floor, hearing the opening bell and throwing yourself into the ensuing chaos. there's something about the place that awes you, that makes you feel small, almost as if you've got no right to be there. everything about wall street was designed to impress, with an entire road lined by towering concrete monuments to money. yet there is a dignity and gravitas about the place, a certain respectability in which the people carry while scurrying to and fro, that makes you think, and hope, that one day, just one day, you can be a part of it.

brooklyn bridgea hundred and fifty years old and still standing, this bridge was the longest suspension bridge in the world when it was built. it was the only land connection between manhattan and brooklyn at the time, the two new york city boroughs being separated by the east river. we walked only half of it since we had no intention of visiting brooklyn, and of all things i met my secondary school junior there! small world indeed.

empire state building
this place is best visited at night, when the air is cool and you get to look out over new york with it's pretty lights. unfortunately when we were there, it was so cloudy that we could barely make out things. on a clear night you are supposed to see even the statue of liberty. a tip though would be to get your tickets from your hotel, which we did, and we ended up jumping ahead of the queue.

times square/broadwayi got to stay just next to times square (thanks to a very special blessing heh) so i was right at the doorstep of broadway. lots of people, lots of noise, and lots of lights. even the nypd police post on times square has a huge neon sign! ticket peddlers, tour operators and imitation good sellers all vie for your attention (and wallet) and as you walk down the street, you get accosted and yelled at by people of various ethnicities and well...voices.

one must catch a show on broadway, and thanks to a tip from dr spacefan, i managed to procure discounted tickets from tkts. yesh, the tkts. went to see avenue q, a puppet show that's not for kids. (remember the list i made before i left? they were all sold out) it's a terrific show, with a shallow facade (fancy songs titled 'the internet is for porn'?) but actually lots of truisms in it. it's politically incorrect simply because it's true in almost every aspect - the temptation we face, the rutts we get stuck in sometimes, the distractions. too bad i was having such a horrid sore throat then - each time i laughed i ended up wincing because of the pain. haha.

the metropolitan museum of new yorkyes, it's the same one that has a store in suntec, and my oh my, is the best museum i've visited so far. and ten bucks (student price) it's also the most affordable. the place is huge, and contains a variety of exhibits, from egyptian mummies to chinese pottery, from music instruments to polynesian artwork. this place needs two days for a thorough visit really, so it's best to come early in the day. i liked the polynesian section because it was unique, and seldom mentioned anywhere else.on our way there, we got a treat in the form of the puerto rico day parade along madison avenue. some two million people lined the streets to cheer the floats on. a pretty spectacular sight indeed (imagine - that's half of singapore's population on those few streets alone!)

the rest of new york
my friends and i took a walk through central park, which is huge and isn't very fun to be at in the summer. then there's the guggenheim museum which was undergoing renovations while we were there. what i love about new york is the subway. it's fast, reliable, and gets you anywhere in new york even past midnight. the station interchanges are like little cities in itself, with shops and buskers, which included anything from stomp-like dustbin percussionists to opera singers to b-boys. amazing. this picture i took at times square station, and i'm looking down onto the tracks from the staircase. it's not a good picture i know, but it shows all the metal and steel that features in all stations. i especially loved the sound of the trains roaring into the staions. heh.and there it is! my travelogue is complete. what an experience it was really, to stay in los angeles for 3 weeks, then exploring two major american cities. if i've got the time, i'll do one post just on the signboards that i photographed during my time there. they're pretty interesting, america being america, so i hope to find time to share it.

for now, that's all folks!

The Hiatus

2008-07-29T21:59:00.000+08:00

mumbler is about to finish up the first of two two-week breaks that she'll have this year (no, not counting the study break right before the final m). it has been a fruitful time, going out with friends, taking time to read up on stuff she hasn't touched in years (literally, in the case of surgery) and enjoying the luxury of sleeping in. no such thing when the next posting comes, because it is s.i.p where she'll become slave to the medical housemen at the grand ol' dame. haha. am actually looking forward to it, because there'll be lots to learn.

met up with secondary school girlfriends for ballet under the stars on sunday. it was a most wonderful time as we ate, watched the ballet, and shared about our lives in the past year. and with lives, i mean current job + men. we stayed back after the performance to discuss the latter topic, and only left when the lights were turned off. heh.

i shall enjoy it while it lasts...

In Summary - San Francisco!

2008-07-28T23:42:00.001+08:00

san francisco is a most lovely place - friendly people, cool weather, and lots of things to see. i'd love to go back there again.

chinatown
much better than the one in LA, the san francisco chinatown was bustling with activity. we followed the lonely planet's walking tour which was pretty unexciting (we've got lots of temples and chinese-y stuff in singapore anyway) but it brought us to places where the book joy luck club was set in. it's one my favourite books of all time, so this was a treat!

here is a picture of the first chinese baptist church where the four women of the joy luck club first met, and it is along waverly street, for which the head-strong character waverly jong was named after.

down one of the alleys is the golden gate fortune cookie factory. even when you're round the corner, you can smell the delicious fragrance of the fortune cookies being made inside. of course, this cookie thing was a clever invention by the immigrant chinese, but you can buy other crispy snacks when you're there. i snapped a picture of a worker making the cookies, and yes, the sign behind her says you have to pay USD0.50 to take a picture.

a few streets away, life is just as it would have been in china - groups of men were clustered around playing games of chinese chess. very quaint and surreal.

fisherman's wharf

this is touted as san francisco's most famous attraction, and it's easy to see why. the cool breeze (even in summer) puts you in a relaxed mood, as you stroll down and see the numerous piers and even more numerous sea cows that have made the place their home. my, did they make a racket!

a visit to the wharf would not be complete without sampling some fresh seafood, so i got myself an oyster while my friend tried the clam chowder. i'll put the pictures of the food on the food blog (which is still under construction, many apologies) but here's the menu for your eyes to feast on. i love seafood, and was tempted to buy one of each type of food!

alcatrazalong fisherman's wharf is the jetty from which you can visit alcatraz. a few decades ago, the name would send a chill any self-respecting crook, because it was one maximum security prison no one could escape from. it was initially used as a military prison, first by the unionists in the american civil war then the us army, it was turned into a federal prison during the tumultous prohibition and great depression periods. the place was designed to be impossible to break out from and the guards had various tricks up their sleeves to discourage the prisoners. there were frequent inmate counts, teargas canisters rigged up around the dining hall, and it was mandatory to have hot showers - not because the guards were kind, but to prevent the inmates from aclimatising to the bitter cold.but in 1946, a bunch of inmates overpowered the officers and gained access to weapons. it would have ended up like a prison break sort of escape if not for the fact that they did not have the key to the recreation yard. two officers died in the line of duty, shot at point blank range while taken hostage. the us marines were called out, and they fired grenades into the cell blocks. the scars from the shelling are still visible at alcatraz. the "battle of alcatraz" lasted forty eight hours, and it's main perpetrators executed 2 years later.

alcatraz has been designated a historical landmark, and visitors can also enjoy the wildlife that has settled on this tiny piece of rock.

coit tower

this 210 feet monument was built by a rich lady in 1933. it was never made official, but from it's design, it was quite likely that it was inspired by the local firemen, who played an important role in the 1906 earthquake which flattened the city.

to get to the top, you must take an elevator (those old ones which resemble a cage) which is operated by a chinese man. as you ascend he recites a well-rehearsed speech about the monument's history. it was well-timed too - just as he finishes his last sentence, the elevator will groan to a halt. the tower offers an awesome view of the city and it's landmarks like lombard street and fisherman's wharf.

lombard street

also known as the "crookedest road in the world", lombard street is one of the steepest roads in san francisco. in order to ensure safety, the city planners included eight "switchbacks" or curves, to allow drivers to slowly make their way down without accident. when we were there, we saw a line of cars all waiting patiently for a trip down. the speed limit here is 5mi/h (8km/h)!

the rest of san fran
while i was there, i also visited the golden gate bridge (completely shrouded in mist), union square (with macy's as a cool backdrop) and ghirardelli square. from the last place i bought a whole bag of chocolates "at a discount", but have been told that it's actually cheaper to get it from a supermarket. oh well. missed trying the ice cream because it was such a cold day, but i've heard it's pretty good. on the last day i took the caltrain down to stanford to visit a friend. it was quite an experience as i was alone and had to figure out how to read a train schedule and locate the platform, which i had never done before! getting to and from the caltrain station was tricky too, but thanks to various local chinese, i made it safely. it was the first time i was utterly grateful to have people of my skin colour around.

and so it is, my san francisco experience! i know i've taken very long with it, and have yet to put up my diary of new york, but i'll do that soon...before sip hopefully! but san fran is a lovely place, and i hope to visit it again in the future.

The Dark Knight

2008-07-22T22:03:00.004+08:00

the dark knight
with all the hype about the dark knight, mumbler was quite excited to see the movie. she was not disappointed, but neither was she completely bowled over. the sequel picks up from 'batman begins' and introduces the character of the joker (heath ledger), who's gone on a rampage through gotham city. on the side of batman (christian bale) is the charming district attorney, harvey dent (aaron eckhart), who's dating batman's ex-squeeze rachel dawes (maggie gyllenhaal). as the movie progresses, the joker's antics become increasingly violent and manipulative, and they finally hit too close to home. along the way, amidst the explosions and flying cars, a character dies, batman thinks of retiring, and the audience wonders what exactly was going through heath ledger's mind when he did those scenes.

as per writer/director christopher nolan's take on batman, this movie is peppered with philosophy and rhetoric, and pits the upright and human batman against the twisted mind of the joker. the movie could have been shorter (153 minutes is pretty long for a summer blockbuster) and certain story developments could have handled better. for instance, mumbler was confused for a while when two main characters were suddenly kidnapped because nothing was shown about the actual kidnapping. nolan jumps ahead and suddenly we find them tied up and professing their love for each other. very queer. and what's with the strange sojourn to hongkong? fortunately the later part of the movie runs along more smoothly, although the ending just isn't quite to mumbler's liking.

i won't complain about the casting because just about everyone plays their role well, except for ng chin han. a fair bit of coverage was given to him because it's rare that a singaporean gets to star in a major hollywood film, but i found his performance lacking in passion. he seemed so distant, his semi-british accent so inappropriate for the movie, that his baddie didn't seem bad at all!

contrast this with heath ledger. he is, of course, the star of the show. even before his untimely death there was a bit of buzz about his portrayal of the joker, and now that he's dead, there's lots of talk about him being given a posthumous oscar. i'm not too sure about the oscar, but it's obvious that ledger threw himself into the role with relish. ledger's joker giggles as he's being punched to pulp by batman and licks his scarred lips when he explains how he got them. you see pure insanity as he laughs maniacally at almost everything - burning a pile of money, wielding a bazuka, or flashing a knife while sharing his preference of knives to guns. and the attention to detail that ledger gives is admirable - i loved the neurotic, high pitched voice he used, the hunched posture and his deliberateness in the way he patted down his hair when he approached rachel dawes in the ballroom. and amazingly, somewhere in that madness is a touch of comedy, like in the way he greets a disfigured harvey dent while wearing a nurse's uniform. nothing quite comes close.

in closing, even though the joker will be his most prominent role, i would like to remember him like this:

how could anyone remember him otherwise?

And Your Time Starts Now (2)

2008-07-15T22:18:00.002+08:00

just after dinner, i received a phone call from an old friend.

old friend: what are you doing now?
me: mugging!
old friend: okay, what else is going on in your life?
me: ...
old friend: so other than your mugging life, what other life do you have?!

the answer is, sadly, none. la-di-da.

And Your Time Starts Now...

2008-07-14T18:30:00.002+08:00

you know that the big M stress is starting to pile up when your friends' facebook status are no longer about the cool places they're visiting but about improving their clinical skills.

A Brief Entry

2008-07-12T22:46:00.000+08:00

three weeks of final year have gone by, just like that. we're less than 9 months away from the big M and there's much to be done.

paeds posting
having a posting at the big kids' hospital has been pretty good, even though it's been fairly dry this week. heard from my classmates in the other paediatrics department in singapore that one ward there has been closed temporarily, making the patients in the remaining ward all overclerked. we've been blessed with nice tutors, especially the registrars, who are super busy but are so willing to teach. we'll need to make better use of our time next week though - much of this week was spent wandering around trying to source for cases instead of actually focusing on work.

"all in a day's work" at the hospital includes helping parents babysit cute infants, playing with nai (non-accidental injury) kids, and comforting a mom who blames herself for her child's condition. that last one...was tough. mom showed no signs of grief until we reached the part regarding initial presentation/birth history. then she wept and blamed herself for "ignoring his high fever for many months till he fainted". she wailed and we felt the eyes of the other parents on us. my cg mate comforted her, and we made a quick exit.

we were pretty stunned, and went through the notes to try to piece the story together. the cause of his condition was neonatal (ie approximately at birth and not later as she mentioned) and i doubt any child could have survived a high fever (t max of 40 according to her) for such a long time. i'm not suggesting that she's lying, but it's clear that she's under lots of stress. someone was suggesting we write in the notes but of course we didn't. maybe we should have written something like ?carer issues, and hope that somebody picks that up.

life
one week to the break. woohoo. am really looking forward to it, not just for the hiatus, but for the jam packed weekend schedule that i already have. lots of meet ups with old friends, meals, performances...yay!

Dances and Daydreams

2008-07-07T20:40:00.004+08:00

mia michaels is a genius. if only i had the ability and opportunity to dance her work.

and the routine for which she won an Emmy for:

just. awesome.

yet another of mumbler's daydreams (when she should be studying for paeds).

In Memoriam

2008-07-03T23:47:00.001+08:00

as if you've never been gone.

GY (1974-2004)

I Can't Believe...

2008-06-29T22:02:00.000+08:00

1) ...the @#$% lot of paperwork that's just been dropped on us regarding the submission of our logbooks. the dean's office just doesn't get it, does it? the student representatives raised the point that it was a waste of time for us to fill in patient id numbers when no one looks at it anyway, and so the dean's office stopped the practice. so we heaved a sigh of relief...and look at what they've done? added a whole lot of stuff to be done just so that our logbooks can be signed and collected. what's going to change is that instead of simply handing in as a group before the deadline and collecting it as a group at any time, the group leaders have to make sure we all sign that we've submitted, someone in the office has to sign that they've received, and we have to sign to collect it.

that probably isn't too bad, but what irks me is that we have to sign an authorisation form and hand it to the person who's collecting the log books. so it can't be the sort of impromptu thing it's been the past few years where the person who happens to be near the hospital can just drop by and collect it. -shrugs- perhaps it's just training for the work that is to come.

2) ...that i'm still interested in soccer. yesh. mumbler has supported germany since the 2002 world cup, and hopes that der mannschaft will do well tonight and deny spain. wahaha. now hit me.

3) ...the huge dollop of favour that fell on me one day recently. i would rather not reveal too much as it ain't the right time, but let's just say that i'm in awe of Daddy's grace. i certainly didn't deserve it, but now that i have it, i shall use it to guide the course for the near future. heh.

The Beginning of The End

2008-06-22T22:33:00.003+08:00

begin with the end in mind, they always say.

i will try not to forget where the true end lies.

An Interruption

2008-06-21T00:05:00.000+08:00

a rather touchy subject ahead - don't say i didn't warn you.

a book was recently brought to my attention because a friend put a picture of it on his blog, and i happened to walk past it at kino today. the book is called "The Third Jesus" by deepak chopra. of course i'm wondering what a guy like mr chopra is doing talking about Jesus, and so i pick up the book, and am most horrified, and amused, at what he writes.

by way of an introduction, i'll just list out what he means by the "third Jesus". according to chopra, the first and second Jesus are historical and religious/christian respectively, while the third one is this mystical being who's contribution to the world's spirituality was to provide us with a way to "God-consciousness", a term that chopra uses frequently in his book. so what he does is to take bible verses and offer a new age interpretation of them, insisting that this was what Jesus meant and that the end result of it all is enlightenment.

i am most horrified by the allegations he makes about the church (that the church has deliberately prevented us from knowing this "cosmic" Jesus) and his teachings that a relationship with God must be "sought for...[because] God is hidden." i shan't go into a theological rant here (i'm not the best person to do that anyway) but suffice to say, this shouldn't be the case.

then again, i find it funny that a person who isn't a christian would profess to know so much about what Jesus taught. i am aware that some of the best bible scholars aren't christian, are in fact muslim or jewish, but who obviously leave the spiritual interpretation to the believers. i don't really know how to describe his new age spin on scripture verses (laughable? sad? unique?) but i'll take it as a compliment - as a testimony to the irreplaceability and power of the scripture.

there seems to be much praise for this book even from priests and pastors, which is surprising because chopra completely ignores basic tenets of the christian faith. and while i'm sure mr chopra has contributed much in helping to "empower" people, i'm also wondering what the nuns who catechised him are thinking.

In Summary - Holiday in LA

2008-06-20T22:49:00.002+08:00

so yes, an overseas elective is a holiday that's meshed with a learning stint. in a place like LA, there's quite a bit to do on weekends, but truth be told, LA is less glamorous than it seems. all that glitz and glamour is only on celluloid, and other than the impossibly tall palm trees and that famous sign, there's nothing to differentiate it from any other city in america. and mumbler's only glimpse of a celebrity was that of, wait for this, gurmit singh. yesh. i flew 9000 miles to see a celebrity from my hometown. do you see the irony of it all?! by the way, he was there to interview the cast of kung fu panda for channel 5. and no, i didn't get to speak to him.

enough of my rambling, here's the lowdown of our LA exploits.

1) hollywood boulevard
that's grauman's chinese theater. built in 1927, it also features the handprints of various celebrities in the front, from gregory peck to sean connery, paul newman to johnny depp. and while we were there, some china supporters were making their voices heard. it was pretty small scale, but they even had the various olympic mascots to complete the picture. the other place worth a mention would be the kodak theater - host of numerous academy awards and two american idol finals. that's it for hollywood boulevard. there's the walk of fame of course, and souvenir and costume rental shops, but that's about it. ripley's believe it or not and madame tussaud's museum are there too, but nothing magical or spectacular.

2) the grove/ farmers' market
these are just next to each other. farmers' market is a food haven. it's kinda like our newton/tiong bahru food centres only with a more international range of food - they even have a singapore stall there which has newspaper pictures of sr nathan and sells laksa for usd9. heh. what i love are the meat dishes - thick juicy chunks with baked beans and baked potatoes...pictures to be up on the food blog soon!

as for the grove, it's essentially a little town of shops which even has it's own fountain and trolley. a great place to take an evening stroll after a good dinner at farmers' market, since you could shop (pottery barn, banana republic), have dessert (cheesecake factory) or simply catch a movie. it's a charming place, and i recommend it. but beware, parking is $5/hour!

3) downtown LA

we went on a sunday, which was a mistake because much of it is a financial district, so the area was pretty deserted. before that we stopped by rodeo drive, which spans three city blocks and has over a hundred upmarket stores. it wasn't just the shops that were cool, the cars that lined the street were just as amazing.

some places to mention: the walt disney concert hall and the cathedral of our lady of the angels. if you've watched the movie get smart you'll find it familiar as the location of the film's climax. it's a rather imposing piece of architecture that was probably part of the city's efforts to rejuvenate the downtown area and it home to the los angeles philharmonic. a few streets away is the church, which is apparently earthquake proof and is the final resting place of actor gregory peck.

also in downtown LA is chinatown, which was as disappointing as it could get. deserted, run down, and looking just like any part of the city, it is, uh, best not visited.

4) the beaches

what's california without its beaches? we took a drive along the pacific coast highway and got to see malibu and venice beaches. the surf was up in malibu, and we took off our shoes (no we weren't expecting to go to the beach!) and ran along the shore as was befitting of the moment.

venice beach had lots of street performers and roadside peddlers, which made for yet another place for a good evening stroll. look at the pretty sunset!5) the j. paul getty museum
recommended by someone who's stayed in LA for 3 decades, this is a place not to be missed. admission is free, and you have to take a tram up the hill to get to the museum. once there, you can indulge yourself in the various exhibits (european paintings, photography, sculptures) or admire the breathtaking view of los angeles that it affords.6) the others
we visited universal studios one hot saturday afternoon (before that newsworthy fire which razed the sets) and drove to six flags and a factory outlet, which are outside of LA, on memorial day weekend. six flags is full of rides for the thrill seeker (which mumbler isn't really, having to sit out the 2 of the 6 rides her friends went because she was getting too nauseous) while the premium outlet is a shopper's haven. and indeed, we all heard a few familiar accents as we made our way through the shops. heh.

so ends chapter 2...next up is san franciso!

In Summary - Life in LA

2008-06-13T21:47:00.005+08:00

a picture speaks a thousand words, so i guess i'll just add a few lines here and there to tell the story of my great american adventure. i'll start off with our LA life. enjoy.

the view of the hospital from the junction of beverly blvd and san vicente blvd. on the left are the wards ("8 southwest" or "5 northeast") and on the right is an entire block of icu wards called the sapperstein critical care tower. i was in the surgical icu on the top floor, and it's referred to as "8 icu" or "8 sapperstein" amongst the staff.

and being on the top floor, it offered a fantastic view of the surrounding area from the bridge. that is beverly center in the foreground, a rather atas shopping centre which is just next to our apartment, and beyond, it's hollywood! in fact, the famous sign is obscured by the bar on the left - that's right, we're at the doorstep of glitz and glamour. haha. no wonder so many stars come as patients.

home was a two bedroom apartment situated right across the road from the hospital. and yes that messy bedstand is my corner. as you can see, mumbler can be quite a messy person.

"hangouts" were jan's restaurant and the grove. jan's was where we'd have an enormous breakfast on sundays which could last us till dinner time, while it was at the grove/ farmer's market that we watched 3 movies and ate several good meals, so both deserve special mention.

there was also church, but 1) i don't have a good photo of the building and 2) it's just an ordinary block shared by various religious groups from the university. what i'd have to love to put up are the photos of the laundry room, but they're with someone who's still happily touring the states right now, so that will have to wait. we spent several hours waiting for our laundry (from wash to dryer it took 2 hours) and met a very gay-looking neighbour who smelled of weed on one of our trips, who kept warning us to be careful because an old man was once shot in the garage. it didn't matter that it was a crime of passion, he spent half an hour talking to us about that in the laundry room.

well, that's it for life in LA. it was only 3 weeks so i never really got to know the area well enough. besides, LA is a place where you must drive. things in LA are very far apart from each other so it's hard to walk around, and the transport system leaves much to be desired. some buses run only once an hour and most run partial services on weekends or don't run at all. we were blessed to know someone who's been living there for 30 years, so we kinda got eased into LA. heh.

coming up next, attractions in and around LA! stay tuned.

Back!

2008-06-12T11:09:00.002+08:00

mumbler is back. and nursing a cold which she picked up right before leaving san francisco. sigh. so now the rest of the week shall be spent staying at home trying to get better before school starts in 2 weeks' time. and while she's on the topic, she's very grateful for her group (barring any changes before the year starts) because m5 is going to be one heck of a long and busy year so it matters who's in the group. heh.

more stuff about the trip to be uploaded in due course. right now i have to concentrate on the unpacking. argh.

Notes From America (4)

2008-06-02T13:31:00.002+08:00

electives are over! can't believe how time flies. it's off to san francisco and then new york. ole!

Notes From America (3)

2008-05-30T15:18:00.000+08:00

1) and so some changes are to be made, likely for the better albeit a bit troublesome. what's more miraculous is that these changes can still be made so late into the planning, so i'm grateful for it. more details when things are finalised. heh.

2) mumbler can't wait for the new x files movie to come out! it's been 6 long years since the series ended. i used to make sure i finished up my homework by 10pm every wednesday night so that i could catch my weekly dose of the show. mumbler loves the x files - she literally grew up on it! imagine, 9 whole years following up on one show. heh. i didn't think i'd look forward to the second movie so much, the last one being a good ten years ago, but now that we're two months to the big release, i can't wait. but till then, here's the official movie trailer. =)

3) the elective is officially over. wow. like, what i had been planning for and worrying about for so long...is passed. oh well. updates when i get back. let me just relax and have fun before m5 starts.

Notes From America (2)

2008-05-24T05:25:00.003+08:00

1) note to self: never chew gum when changing a patient's wound dressing. tried it today and i nearly puked. it's like in first year when i drank ice lemon tea right after anatomy class and thought i was drinking formalin. never again.

2) my team is being very nice to me today. "no need to come on monday" and "let's see how we can get you out of here early to enjoy the weekend." so it's hello memorial day weekend baby! i shall join the throngs of americans milling around town during this extended weekend. but that's if the weather holds up. it's like 13 deg C today and it rained. nooooo.

that's all for now. till next time.

Notes From America (1)

2008-05-22T12:59:00.003+08:00

i know i haven't blogged since arriving in the states, so here's some random stuff:

1) mumbler is safe and sound...and a little cold in los angeles. over the weekend, the weather was scorching hot, and it crossed our minds that we had flown a couple thousand miles only to experience singapore's weather. heh. fortunately the cool, dry wind is back.

2) david cook is the new american idol. this is, like, breaking news. after talking up david a for the entire season, simon cowell went too far and criticised david c just a bit too much during the final. so i'm glad that david c won, because i love his rendition.

3) hospital work is a-ok. team is quite friendly, although most of them are preparing to leave for different postings soon. the team has two indians, two african-americans, one japanese and me, chinese. the only angmohs are the attendings. and that's how it is in the surgical department here at cedars - quite a substantial number of indians and asians. and a point i must mention is the free food that comes with any tutorial/journal club etc. there's always some pasta and fantastic dessert, including the most wonderful brownies!! sigh. if only the food back home tasted that good. then again, that's the reason why the americans are so f-a-t. they even have special beds to withstand the enormous weight. not surprisingly, doing bariatric surgery is very lucrative. heh.

4) staying in an apartment has been quite a blast. laundry, meals, sleeping arrangements, 2 sets of house keys shared between four people, gossip and jokes all make for lots of laughs that keep us up when we're supposed to be studying or sleeping.

that's all for now. gotta go cuz there's a queue for the comp.

Wrapping Up And Looking Ahead

2008-05-05T22:32:00.000+08:00

[why didn't blogger save the post before my browser hanged?! argh!!]

part one
anyway, i'm going to miss the hotel o.n.e. DEM. like, really really miss it. the people, the patients, the "work". yes, it's "work" because students have it easy there - my main job was to set plugs, take blood, and serve the occasional biscuit and milo to hungry patients. none of the "please do not crowd inside my resus room -- only one visitor at a time, not five!" or "i have already explained to your brother/sister, so you should speak to him/her, there's no need to raise your voice at me!" or trying hard not to upset the delicate balance of beds upstairs. i still recall the night where there were no icu beds and the resus was overflowing. haha.

for my part, i'm glad that i am now pretty comfortable with setting plugs and catheterising patients. considering i had done no more than five plugs and had only one extremely embarrassing catheterisation ("it usually doesn't take half an hour") under my belt before i entered this posting, i think that's great. heh.

and who could forget the varied patient encounters? from the sad (old man who lives alone coming in for scabies) to the funny (mdm sing-song, mr i-filled-up-a-feedback-form-praising-you) to the annoying (son who refused to budge from the consult and who glared at the attending doctor with an open look of distrust), i think i can safely say they were probably the most memorable, compared to other postings.

of course, what i miss most would be the doctors. this is the first department where almost everyone was so willing to teach and talk to us. by letting us shadow them from patient to patient, i learnt more than just medical facts. i saw lots of pr skills (man do you need it in the a&e), practical tips (ie ways to *ahem* save time) and kuoli tricks. from the most senior/famous people to the MOs, i was touched and amazed at the spontaneity of teaching. even the busy nurses would grin at us and say "hello". that's what i call a positive experience. heh.

part two
i have these few days as a breather before i fly off to the states. shall be doing 3 weeks in surgical critical care at cedars sinai (aka the britney spears hospital) and followed by 2.5 weeks of traveling. will be doing a little jaunt in and outside california, before flying to new york, new york. am most excited about that part of the trip. nearly hyperventilated when i saw the list of shows on broadway. i want to watch ALL of them! but oh well, based on recommendations and personal interest, i've narrowed the list down to only five(!) shows:

musicals: jersey boys, billy elliot, wicked

plays: cat on a hot tin roof (starring james earl jones!!)

off broadway: john lithgow - stories by heart

i want to watch the musicals because...well, i love musicals. totally dig them. les miz got me hooked and i've been on a roll ever since. i missed the chance of watching nathan lane and matthew broderick in the producers when i was in london, so i mustn't let that happen this time. the two plays are equally enticing - james earl jones in a tennessee williams play and the fantastic john lithgow recounting his early influences as an actor. one word - wow.

seems that billy elliot's already sold out, and tickets to jersey boys are going fast! will have to try my luck at the discount booth (many thanks, dr s-!). before that, i'll have to convince my travelling companions that we must, must, MUST catch something on broadway. heh.

cryptic notes to self
1) much tolerance required
2) such curious creatures they are

ignore me. they're just little notes to remind myself of the frivolity of my (perceived) youth.

it's back to the packing. here's to the land of the free!

No Greater Love

2008-04-28T00:23:00.010+08:00

some background first: i've been helping out with the hfmd screening at church these past few weeks, and so have missed praise & worship for some time. not only that, i've been feeling a little dry, and to top if off, the events of the past few weeks haven't been exactly uplifting (see previous post).

so it was more than just a pleasant surprise when pastor gabriel announced before service started that darlene zschech would be leading worship!

what an amazing p&w it was!! the songs (salvation is here - at the cross - nothing but the blood - how great is our God - healer - Hosanna), the music, the singing. during worship, i cried. not bawled, but yes i did shed a few tears. i cried as the frustrations of the elective planning fell away, as the uncertainties melted, as i was reminded that i am still, and will always be, Daddy's little girl.

because it had totally slipped my mind that i was serving for 4th service hfmd, and i was frantic when i saw the roster the night before as i was supposed to rush down for the afternoon shift at hotel o.n.e. after service. i didn't want to be late so i called people and tried to swap duties.

if i had managed to change duties, i would probably have made it to hotel o.n.e. much earlier. well, i wasn't successful, but what was in store for me was precisely what Daddy knew i needed most. thus preserved, i had those precious minutes of fantastic worship which i will treasure. precious because i'm leaving for the states soon, and not only am i going to miss hillsong united's concert in singapore, i'm also going to miss the p&w that i love for 5 sundays.

to end this post, here's the one and only darlene zschech:

At the cross I bow my knee
Where Your blood was shed for me
There's no greater love than this
You have overcome the grave
Your Glory fills the highest place
What can separate me now?

You tore the veil
You made a way
When You said that it is done

Speechless...

2008-04-26T22:56:00.001+08:00

...with anger that is. when somebody p*sses you off big time and points a finger at you, what do you do? what do you say? i know my limits, and i know my limits are being tested now. any more, and things will come apart at the seams.

a few of you have asked me on facebook what's wrong. thanks for your concern. i'm not at liberty to furnish the whole story now because there are too many questions and a number of people involved. and also because i don't like to whine like some people to the whole world so that half the class knows only one side of the story. these people give us only children a bad name. but yes, thanks, i really appreciate it.

i wished blogger had a password-protect function. then i can rant as much as i want.

Of EMed (6)

2008-04-24T22:53:00.002+08:00

summary of today (a&e is giving me blogger's diarrhoea!)

1) hepatic flap. my first. jaundiced patient with a history of alcoholic liver cirrhosis, came in for a fall at home. he was totally zonked out, so likely stage 1 or 2 hepatic encephalopathy. he even has inversed sleep patterns! wow.

2) posterior dislocation and elbow dislocation. not in the same patient of course, but two patients who came in at the same time. stayed with the elbow dislocation, who's a judoka in junior college. took him some time to be sedated, and even then he was able to tap the mo's hand pretty firmly when the mo was reducing it, all the while with his eyes half open. haha. i love watching reductions with the accompanying "conscious sedation". m&rs are such wonderful things - simple but very effective. and the conscious sedations make the patients so loopy that it's really hilarious to watch. (i'm starting to sound pretty unsympathetic am i?) but nothing can beat watching a kid come out of ketamine haze. heh.

3) trauma team activation. pretty standard - drunk tourist knocked down by lorry, but it was the details of the activation that got me thinking. shan't elaborate too much here because they aren't pleasant stuff.

off day tomorrow. time to tie up loose ends for the overseas elective, and to attend care group. i miss it.

Of EMed (5)...

2008-04-23T18:23:00.003+08:00

...and more things. spent some time yesterday reading through old entries and realised that this blog has degenerated into nothing more than a record of my days in medicine. so dry and uninteresting, unlike other blogs out there. anyways.

the madness
these two days in the ed have been madness. even though hotel f.o.u.r. was open, we were swamped with patients. it was patients, patients everywhere - in rows of three between the panels, in the corridors, in wheelchairs because there were no more trolleys... resus was overflowing with up to eight or nine patients squeezed into that tiny area. so what, you might ask, is worse than having many patients? what was worse were the anxious and irritable relatives who entered the p2 area in droves and refused to leave. i saw the poor security guard do many shuttle runs between the two main entrances to the ed trying to stop the relatives from rushing in despite being told to wait outside.

as for those who made it past the guard, they either hovered around their sick relatives and interrupted the consultation or went round demanding that they be seen first. one woman i saw stood in the middle of the sea of patients and yelled at a nurse, saying, "i've been here two hours!" like, has she been to an a&e before? since when was a 2 hour wait considered long? did she think the doctors were hiding in a comfortable room somewhere, sipping tea from porcelain cups and listening to smooth jazz while the a&e overflowed with patients? argh.

and so the sad thing about being a medical student is that we aren't qualified to help. we can't help the doctors see the patients, type in consult notes or examine them - anything to help clear the queue faster. if anything, we probably slowed them down because they had to explain to us certain things and watch us inexperienced blood suckers take blood or set lines. felt really useless, especially when i saw the constant stream of patients wheeled in.

what's amazing, however, is that the docs still took time to teach us. they were all partially crazed, eyeballs bulging, from the nonstop work, but they managed to explain details coherently to us. hats off to them man.

VVIPs or otherwise
cases wise, it's been quite a field day (or rather, days) for us. first thing when i walked into resus yesterday, i had to perform cpr on a patient brought in initially for urosepsis but who subsequently developed a massive anterior infarct. then we handled a standby case of a man with severe sob, who turned out to be the ex - of -. (haha did you think i'd reveal his identity?) mumbler's first brush with a vvip; jaw kinda of dropped when told by dr -. yeesh, not a vip but a very very important person. and to think i was calling him "uncle" the whole time. goodness.

saw a patient with suspected hiv today, who came in for a painful inguinal swelling. ex-ivda who had so badly damaged his veins that they had to set a line in his neck. he was cachexic (with temporalis wasting) despite reporting loa for only four days. white cell count was high (26!!) but lymphocytes within normal limits. still, the suspicion was high so i think they went ahead to test him.

as one doctor said, things always come in twos. an hour later, a man was brought in for a heart attack, and it turned out that he was hiv positive, but hadn't told any of the attending doctors. fortunately for the computerised records, which documented visits to the cdc. whew!

and to round up the day (it was only a 4 hour shift!!) we saw a patient who had a horrific crush injury after a one ton metal bar fell on his hand. there was partial amputation of his hand and various parts of his fingers, so we could see the bones and tendons that tenuously held the two halves of his hand together. it was likely that he would need an amputation of the distal phalange on one of his fingers, but the worst case scenario was having that on 3 of his fingers. hand mo said it'd be long op, so they're probably still operating on him right now. hope it goes fine!

american idol
just because it was andrew lloyd webber night, i decided to watch american idol and sit through it. haven't been able to that the past few seasons and since i knew the material tonight better, i thought i'd enjoy it. was pretty impressed with syesha's and david's rendition of webber's hits, but was absolutely dismayed with jason's "memory" and brooke's "you must love me." since you've made it so far in this competition, surely you'd want to research more on your songs and try and sound better than this?! can't believe they totally destroyed the songs. and i didn't share the judges' enthusiasm about david cook's "music of the night." thought that he actually could sing it well, but the magic wasn't there at all.

to hear what magic is, follow this link. this is a tape of a live performance featuring the original phantom, michael crawford. his voice gives me goosebumps. now that is magic.

so ends my one and only ai post, only because alw is a genius. heh.

Of EMed (4)

2008-04-21T17:56:00.004+08:00

nothing much last night - had the standard cases of vomiting, chest pain, breathlessness. some flurry of activity occurred when a standby was called for a patient in status (epilepticus) and a russian patient, whose only english word was "cold", came in for haemetemesis. got to do some t&s, catheterisations and lots of blood taking. still need more practise in setting plugs - i managed to set a green one last night after failing two blue ones, how ironic. granted, i was successful because the patient was a young, albeit whiny army boy while the other two were older folk, and one of whom kept wincing in pain when the needle was in. like, from the first poke she was already hissing and clenching her teeth. to cut a long story short, i harm-ed and so asked dr s- for help. sigh.

and talking about the whiny guy, he presented with blood in his vomitus after an all night drinking binge. said he started at 11 the night before and lasted till 4 in the morning, and drank a couple of martell's. during the consult, he kept checking his watch and sighing about how he had to report to camp soon and that his friends were waiting for him outside etc etc. it wasn't his first time at the er for such a problem, but he made quite a big fuss when told about the possibility that he might have to be observed. like, whatever. it's not as if the medical staff were waiting for him to turn up!

forgot to mention about the man with scabies we saw on friday night. from afar, we spotted him scratching his legs furiously and moaning in pain. we approached him and saw that with each scratch, a whole lot of skin flakes fluttered onto the bed and the floor below. his skin was all red and bloody from all that scratching. needless to say, we were both repulsed and full of pity for him. he said he lived alone, and when i took a look at the address, it wasn't in a good part of town. it's so tough with patients from such backgrounds - this gentleman actually bore the itch for over a month before coming in to hotel o.n.e. for some weird chest pain. i'm not sure how his follow-up is going to be like, but i certainly hope he somehow gets rid of the scabies in his home.

anyway, the latest batch of urine bags has been a giving us a problem - they leak. first time i did a cath alone, it was with a faulty bag, how exciting. heard of one patient who ended up changing like three or four bags because they all leaked. haha. it's like some russian roulette now, seeing who gets the leaky urine bag. heh.

Of EMed (3)

2008-04-20T09:53:00.000+08:00

my, are the posts coming in fast and furious.

resus was pretty busy on friday night. had an ami in one panel and then five minutes later another was wheeled in, much to the dismay of the doctors involved. one thing i've noticed about ami patients is that some of them don't seem to realise the severity of the situation. ami is one of those "run of the mill" emergency cases where the management and protocols are like reflexes to the medical staff so if you get treated early, you'll get a "run of the mill" outcome - a discharge after three days. before the days of pci (percutaneous coronary intervention ie balloons, stents, etc) and thrombolytic therapy, i doubt the survival rate of a heart attack was as high as it is now.

so it is a bit surprising that some patients either refuse treatment or request a delay in it, citing reasons such as "an important meeting tomorrow." it can be one of two things - denial, or the sad state of our lives in the present world, where losing our jobs strikes greater fear in us than losing our lives. each time i've had to resist the urge to shake the patient and say,"sir! if you don't get treated now, there will be NO tomorrow!"

almost all will eventually consent to treatment, but i've read the casenotes of one who went through four ami without agreeing to intervention. amazing.

had a bit of fun in the p2 area when a woman was wheeled in. she's apparently a frequent visitor of our hotel, and knows all the medical staff. she had all those buddhist prayer beads and some round contraption that chimed, and she went from nurse to doctor to medical student reading palms. she broke into song several times ("three, four, buckle my shoe" and the ever popular 上海滩) and made interesting phone calls ("darling are you coming to pick me up?" and then suddenly "what do you mean, mm? i'm not staying!") even more hilarious was her reaction to a moaning, confused patient - a loud and emphatic "diam!!" which of course did nothing to stop him from moaning.

i wonder who will come through the doors tonight?

Of EMed (2)

2008-04-17T10:37:00.003+08:00

if you ignore the crazy long lists of patients, the a&e is really a fun place to see all the weirdest cases ("patient complained of a tingling sensation in fingers after touching atm about an hour ago") and patients. had a full day at the p3 area last night (on tuesday it was eerily empty) and what an assortment of patients it was that came in through the door!

to start off the shift, we had an rta patient who refused to pull down his pants because he wasn't wearing any underwear. he didn't speak english so we were initially puzzled at all his gesturing and pointing. it was hilarious. eventually we got a translator to tell him it'll just be him and the doctor and that it was necessary to check his leg (he c/o pain over left hip and thigh.)

then we had a pretty hotel staff who had fainted while at work. her referral from her gp (from a very famous chain of clinics) was unreadable. the piece of paper came in a series of strokes and dots and at one part, something that looked like a drawing of a heart! she was very pleasant and demure, and was a bit embarrassed when d.c. tested her upper arm strength.

there was also a jc girl who sprained her ankle after falling down the stairs. she came in on a wheelchair reading her economics lecture notes, and of course uncle just had to talk to her, and he started to explain the economics - of bgr.

some unpleasantness came about when we had trouble admitting a patient. i can't say much here, only to say that there's a limit doctors can do in helping someone and ensuring they stay healthy. sometimes the consultation ends in the signing of the AOR form, and all that's left is to lift up a small prayer that the patient will not make a turn for the worse.

that's all for now. gotta head back down to hotel o.n.e. soon. another night ahead. heh.

Of EMed (1)

2008-04-16T01:16:00.000+08:00

a super long tutorial makes for a super happy emed kid. heh.

Of The Weekend

2008-04-15T10:23:00.000+08:00

the anatomy of a crazy weekend:

saturday
wake up - dance class - lunch - nap - leave for hospital - start shift

sunday
end shift - nap - brunch - church - dinner

to round up the weekend, i got emails bringing bad news about our apartment in la (sounds like they're trying to cheat us) and hearing other things that i didn't want to hear.

as it is, at the end of service, the worship team chose to sing this wonderful song by reuben morgan:

One Day
More than I could hope or dream of
You have poured Your favour on me
One day in the house of God is
Better than a thousand days in the world

So blessed, I can't contain it
So much, I've got to give it away,
Your love has taught me to live now
You are more than enough for me
Lord, You're more than enough for me

He's more than enough for me indeed.

Of Night Calls

2008-04-13T03:12:00.000+08:00

all quiet on the western front for now, so taking a break to read from the trusty e med handbook.
just found out that the grand ol' dame's computer system blocks facebook...because it's classified under the "personals and dating" category. like, huh? no fun one.

Of Late

2008-04-10T21:49:00.002+08:00

watching the juniors in the er now gives me a glimpse as to how much we've grown (clinically, i mean) this past one year. they are fairly lost (but finding their way round quickly) and are clueless about many medical conditions. not only that, they are still very sensitised.

case in point: young foreign worker found collapsed at worksite, apparently electrocuted. arrived in the er asystolic. after half and hour of resuscitation, the doctors called it, and i saw the shock on their faces as everything was turned off. one exclaimed, "but he's too young!" i just didn't know what to say when i heard that.

central hospital's emergency is sometimes closed several times a day, and during that time, all ambulances are diverted to the grand ol' dame. not surprisingly the p2 area becomes quite crowded, and the patients resign themselves to a long wait. what i found interesting was the various ways that the patients occupied themselves. most slept but there were those extroverts who struck up a conversation with the person in the next trolley, those who read (reader's digest and novels) and a young man who must have finished half a book of soduku while waiting.

since the staff are so busy, we medical students act as nannies, making sure patients don't fall out of the trolley trying to get to the toilet. some demented patients have no idea where they are and attempt to climb out. we tell them that they're in a hospital and they calm down a bit, but we know very well that in an hour's time, they'll be trying their very best to escape again.

"idol gives back" featured one of my favourite songs, from the musical Rent! here it is.

Seasons of Love

Five hundred twenty five thousand six hundred minutes,
Five hundred twenty five thousand moments so dear.
Five hundred twenty five thousand six hundred minutes
How do you measure, measure a year?
In daylights, in sunsets, in midnights, in cups of coffee.
In inches, in miles, in laughter, in strife.
In Five hundred twenty five thousand six hundred minutes
How do you measure a year in the life?
How about love? How about love? How about love? Measure in love.
Seasons of love.

Five hundred twenty five thousand six hundred minutes!
Five hundred twenty five thousand journeys to plan.
Five hundred twenty five thousand six hundred minutes
How can you measure the life of a woman or man?
In truths that she learned, or in times that he cried.
In bridges he burned, or the way that she died.

It's time now to sing out,
though the story never ends let's celebrate remember a year in the life of friends.
Remember the love! Remember the love! Remember the love!
Measure in love. Seasons of love! Seasons of love.

A Toast

2008-04-06T22:08:00.000+08:00

here's to e med!

Wow

2008-04-02T23:23:00.003+08:00

a better turn of events today - something unexpected but good enough to remedy last night's displeasure.

watched the bucket list today. touching film which stars heavyweights jack nicholson and morgan freeman. it's about two men given less than a year to live because of advanced cancer, trying to live out the remainder of their lives with meaning. they make out a list of things to achieve before they kick the bucket (hence the title of the movie) and set out to do it. along the way, their contrasting life histories and priorities come to a head, but is resolved, tragically and touchingly, when one of them dies.

nothing much to comment on the two leads (like, hello?) as they were predictably awesome - restrained, joyful, bitter and contemplative all at the right time. i loved the digs at nicholson's personal life ("been married four times but i still loved the single life" and "i've been making money since i was 17 and have been pretty good at it") but the plot is kinda predictable and the characterisation cliched (rich, atheistic, unrefined white versus a poor, intelligent, religious black) so that was a bit disappointing for me. otherwise a pretty good film -- i'll give it 3 stars.

Culture Vulture

2008-04-01T22:44:00.000+08:00

had the opportunity to immerse in some cultural stuff last weekend.

first up was giselle at fort canning park. it's something like ballet under the stars, where you bring your mats and food and enjoy the ballet. the ang mohs really made it into a big outing, with bottles of wine and picnic baskets containing delicious looking food. there's nothing quite enchanting to watch a ballet in a park at night, with the cool wind blowing through one's hair. xia haiying was amazing as the ill-fated giselle, who gets cheated in love but who eventually forgives the jerk. as a dancer she's outstanding (i always think that the easier you make a dance look, the better a dance you are) and as a performer she evoked appropriate emotion. i really felt quite sorry for her as giselle danced away at the end, condemned to be a wili for eternity. heh.

then it was sam hui's concert. went only because my parents like his songs, which are all in cheem cantonese and are thus all greek to me. i enjoyed the audience banter, especially that of his younger brother. it was hilarious and sent the entire stadium roaring with laughter. what amused me was the group of middle aged women who were obviously long time fans. they were armed with their signs, song requests and gifts (wooden sculptures, bouquets, stuffed toys) all ready to please him. and when he came down to the audience to shake hands, their screams of adoration would probably have made their daughters blush! what a sight.

and on sunday, it was we will rock you. coming from a non-queen fan, i must say it was amazing! the story sucks of course (really bad and cheesy plot about a time in the future when music is banned) but i don't think queen fans will care for a meaningful story. it was a riot, what with the hilarious digs ("victoria beckham saved us!") and local references ("sorry lah!" and "this suit is not from armani, it's from bugis street.") the cast was pretty good, but what a gem mig ayesa was! he came in third in the search for a new lead singer for inxs, and it's clear why. i've never heard such a fantastic voice 'live' before, and it really blew me away. on top of that, he's a good dancer. i had fun, and even this young caucasian kid who stood up in his seat at the end of the performance and started doing a mini john travolta thing. haha. a must watch!

**

some other stuff: honestly, some people need to be shaken up a bit. it's not the first time this person has done this, not to me but to a whole lot of people. it's not just basic courtesy, it's also responsibility, and if a someone can't even do that, i think it's very sad. c'mon, grow up already.

Of Being Unethical

2008-03-28T22:15:00.002+08:00

mumbler is unethical. so says the results of the ethics "test". wow-wee.

"watch out for dr mumbler!"

i really should make a bumper sticker out of this.

Of Brief Notes

2008-03-27T23:53:00.000+08:00

just got back from "giselle in the park" by singapore dance theatre. have never been to ballet under the stars, so this was quite an enchanting experience. took pictures of the sunset sky, and they're lovely. heh.

am approaching the end of my second month of electives. fifth year is drawing nearer, and even though i know i've learnt quite a bit so far, final mb seems an impossibility for now.

electives need to be settled, as well as other things outside of medicine. i'll blog in more detail next time.

Don't Ask Me About This - Still Reeling

2008-03-01T17:06:00.003+08:00

still reeling from a comment i heard more than 24 hours ago. still reeling because it comes from someone i really look up to and really respect, and because it's so true. i don't think anyone was meant to hear that comment, only the person to whom it was spoken to. but since it was reported to me, i now know it. maybe this was the push that was long overdue, or maybe the person didn't mean it. but whatever the case, that i -do- know, then amends have to be made and priorities readjusted.

and like the title says, don't ask me about this. just don't.

Of New Experiences

2008-02-24T20:51:00.016+08:00

what a week. on thursday i had my first taste of serving during care group, and over the weekend i had a chance to venture to a place i've never seen before - batam. here's the photo journal of the experience:

first glimpse of the village

the chaos before we begin

things settle down with the help of the army doctor

the pharmacy

the idyllic fishing village...

...where there are flimsy boardwalks instead of footpaths...

...and kids play goli on hot afternoons

the scene at the second village. notice the queue snaking out the door

the kid named power

praise and worhip during sunday service

kids at sunday school!

both teams saw nearly 700 patients in one day. they were more a blessing to us then we to them. even though i didn't get to interact much with the local folk since i was assigned to the dispensary, it was apparent that we were doing something useful for them. the fishing village at barelang was our first stop, a place where the kids flew kites and played the traditional game of goli after lunch, and goats coming to sniff at our medication box. the adults mostly had high blood pressure from eating salted fish so medication and advice was given regarding that. this seems to be one of the most rural places this mission has visited, so rural that there are no roads only dirt tracks, and you have to close all the windows in the van to prevent yourself from being coated with a fine layer of brown sand.

the next village was not as rural but had a huge turn out, much more than was anticipated. not surprising though, since each mother came with three to four children in tow, all sick. soon, the lot of us were very deft at counting pills, writing out labels and diluting antibiotics! haha.

sunday service and the mission clinic was held at the bible school which is our contact in batam. it was an uplifting service, not to say the least when they opened with a new crea p&w song! amazing where the grace preaching can reach huh? even more amazing was that the kids in sunday school were learning it too, with actions included! that really made my day.

it's back to the wards again tomorrow, but i'm certain this won't be my last trip to batam. heh.

Of Great Leaps

2008-02-19T23:08:00.000+08:00

this month has been and will be a month of great leaps. decisions to be made, both for myself and on the behalf of others, steps into the unknown, and self-reflection. have no idea how all these things came about, but yes, amazing grace shall lead me through.

Of A Close Shave

2008-02-08T20:38:00.000+08:00

while driving these two days of the lunar new year, i saw several car vehicle accidents, one so bad that one of the cars involved had its trunk smashed in and the brake lights all hanging out. and of course i thought to myself, man i am so -not- going to get into an accident at this time of the year.

guess what? i nearly did.

i was heading down buona vista road today and was approaching the junction just next to the moe building. the lights were green for those going straight and those turning right towards ghim moh, so i just kept my course.

all of a sudden, this car coming from the opposite direction turned and ended up right ahead of me. for a split second, the driver did not even notice me and kept going, keeping us in a collision course. then in the nick of time the car stopped, and all i had to do to avoid an accident was to swerve to the left.

i wonder, had not the car been of such a garish colour for me to notice it (the car was electric blue) and had there been cars to my left, if a horrific accident would have happened. the car was right ahead of me and at the speed that i was traveling (which isn't fast since my car can't go beyond eighty without complaining) i could not have stopped in time. we might have just bumped bumpers, but at worst, bonnets would have been crushed and injuries sustained.

i have no idea what that silly woman in the other car was thinking. maybe she was arguing with her passenger, maybe she didn't see me because of the concrete divider or the sun was in her eyes, maybe she was new driver with poor judgment. whatever the case was, i am grateful that everyone's in one piece. my parents didn't realise what was going on until i swerved. haha. thank God!

paeds elective starts next week, and i sure am looking forward to it! heh.