Conversing with Life

Purpose of this blog

2007-05-10T19:38:00.000+08:00

When I started out blogging, I wanted to blog down my experiences as a final year student preparing for the MBBS. When I passed the exams, I felt that my experience as a HO would suffice me to continue my blog.

It has, and it has been such an experience.

I glad I managed to capture my many emotions and thoughts as I went through the HO-ship. And no doubt, I will spend many hours re-living the HO moments when I read through my previous posts.

My introduction to this blog is: "Tackling life's issues: as a final year medical student trying to figure out how to juggle family, relationships, studies and sports."
And to motivate myself, I had this quote: "Use what talent you possess: the woods would be very silent if no birds sang except those that sang best." -Henry Van Dyke-

Now, as I finish my HO journey and start on another longer journey, I guess this blog has out-lived its purpose.

Do I continue to blog? This question has been bugging me for some time and I haven't quite made up my mind. But I will take some time off.

One good thing about this blog is that I've actually made quite a few friends through the blog and strengthened some friendships through it as well.

I don't know how many people actually are still reading this blog, and how many will actually miss this blog. But thank you to those who have visited my blog, left comments. Do continue to keep in touch.

Till then.
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Do keep in contact with me via email (daigoleow@gmail.com)

For the new HOs

2007-05-04T20:28:00.000+08:00

As you begin on this exciting yet apprehensive journey, you will realise many things.

You will realise that there's many things to be learnt, yet some theoretical knowledge may not be practical.

You will realise that you are pushed to your limits, yet know that your limits are actually further than you thought.

You will realise that no man is an island, yet will feel lonely during your nightcalls.

You will realise that some patients just irk you, yet realise that you are doing this job because of them.

You will realise that your whole life is consumed by work, yet you yearn to have time off to do other things.

You will realise that this journey is hard, yet you will feel a sense of accomplishment when you finish the journey.

Good luck in this journey.

The next step

2007-05-02T20:01:00.001+08:00

From HOs to MOs.

12th month HO

2007-04-30T10:11:00.000+08:00

I quote someone, "No one is more dangerous than the 12th month HO."

I disagree with that statement. The 12th month HO is in fact the safest HO, because the experienced HO knows how to handle the different scenarios that can happen to a patient and is able to institute immediate life-saving measures promptly. Other than being proficient in the daily procedures, he/she is also able to navigate the hospital administration and get urgent scans or operations arranged.

If I may alter the statement, "No one is more dangerous than a HO who doesn't care."

And that is the pitfall we must refrain from. Although the end seems near, patient care is ever ongoing. We cannot stop caring and must always do things in the interest of our patients.

Unexpected

2007-04-24T20:18:00.000+08:00

When you least expect it, life turns around and whacks you in the face.

If you take life for granted, it will disappear in an blink of an eyelid.

Grab life by its horns, and learn to live every moment.

Appreciate everything and everyone in life, and live without regrets.

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In remembrance of a loving grandfather...

Yoga-man

2007-04-14T18:21:00.000+08:00

Omm...
I feel really stretched and relaxed

Omm...
Even though it was expensive

Omm...
I think it's worth the experience

Countdown 1

2007-04-11T22:09:00.000+08:00

21 days more to go

Changes

2007-04-09T22:18:00.000+08:00

Go do your changes.

That's the term we use for the work that is ordered during the morning rounds.
It's encompasses a wide area of stuff, from:

taking blood
getting scans
doing discharge summaries
referrals and reviews
updating family
off drains, lines
inserting lines
summarising old notes
retaking history

And I'm sure the list goes on and on.

But whatever the changes are, we just have to do it.

At the start, I used to wonder why some of the changes are ordered. And also their significance in the management of the patient.

But somewhere, somehow, along the way, I've stopped wondering.

Because sometimes changes are ordered too arbitary.

"We haven't done bloods for a week, let's repeat them."

"Go get this scan urgent. I want it by today."

"Refer this patient urgently for left little toe itch."

It doesn't matter what the changes are, we just have to do them.

It doesn't matter how useful they are, we just have to do them.

It's too routine, we don't have to think.

Just do them

The 1-man HO

2007-04-05T20:34:00.000+08:00

Tired = Satisfying

Flustered = Challenging

Yardstick

2007-04-02T22:13:00.000+08:00

A measure of a man is by the way he handles the obstacles in his way.

A measure of a surgical HO is by how he/she survives the vascular team posting.

Please pray for me.

Waht!

2007-04-01T20:53:00.000+08:00

fi yuo cna raed tihs, yuo hvae a sgtrane mnid, too.Cna yuo raed tihs? Olny 55 plepoe tuo fo 100 anc.
i cdnuolt blveiee taht I cluod aulaclty uesdnatnrd waht I was rdanieg. The phaonmneal pweor of the hmuan mnid, aoccdrnig to a rscheearch at Cmabrigde Uinervtisy, it dseno’t mtaetr in waht oerdr the ltteres in a wrod are, the olny iproamtnt tihng is taht the frsit and lsat ltteer be in the rghit pclae. The rset can be a taotl mses and you can sitll raed it whotuit a pboerlm. Tihs is bcuseae the huamn mnid deos not raed ervey lteter by istlef, but the wrod as a wlohe. Azanmig huh? yaeh and I awlyas tghuhot slpeling was ipmorantt! if you can raed tihs forwrad it.

Blue skies

2007-03-27T15:59:00.000+08:00

Work has barely started and I already miss the sunny skies.

If I wasn't working...

2007-03-24T16:31:00.000+08:00

Waking up after the sun rises.
Having a Mac's big breakfast, just before it stops selling them.
Spending the whole day just lounging.
Running in the hot noon sun.
Watching drama serials the whole day.
Cleaning up my room.
Just pondering about life.
Making a gift for my love.
Eating non-stop and worrying about putting on more weight.
Climbing the whole day.
Catching up with old friends.
Exploring the island.

PEACE

2007-03-20T23:06:00.000+08:00

Finding peace.

The ones at our side

2007-03-20T20:24:00.000+08:00

I have a bad temper.

Those who know me may know it, or even experienced it.

When I'm in a bad mood, and I don't feel like talking to anyone; I shut everyone out.

Everyone.

I take my family for granted, not realising that they are the ones behind me, besides me, when I need them most.

I lose my temper for no reason, often I just want to be alone.

Maybe it's just my lonesome personality; maybe I just want to keep my troubles to myself.

But whatever it is. I realise I should not take them for granted.

I should appreciate them, because if I don't; I'll live to regret it.

Helping out

2007-03-19T21:33:00.000+08:00

Vacuumed the floor today. Realised how long it has been since I last did chores. Ever since HOship started, I've been so tired after work to even help out at home. My parents have been tirelessly keeping the household going and clean. Thank you mom and dad.

What are we struggling for?

2007-03-19T18:39:00.000+08:00

Like mice we run in this maze of life.

Trying to earn our keep and a lifestyle we yearn for.

We spend our whole lives doing this, hour in hour out.

But what do we really yearn for?

What makes us happy?

What is happiness?

Does this road that we are running on lead to happiness?

Are we sure? Or are we hoping it does?

Because if it doesn't, then we would have been running for nothing.

Because life doesn't repeat itself.

Leave me alone

2007-03-18T20:51:00.000+08:00

Sometimes we all need some time alone.

Passive HO

2007-03-11T21:27:00.000+08:00

The 'passive' passive HO:
1) Phlebotomist
2) Paracetamol prescriber
3) Cleans up other people's mess

The 'active' passive HO:
1) Ensures patients get the necessary treatment and medications
2) Provides prompt emergency assessment and treatment
3) Gives continuity of care over the night

Helpless

2007-03-10T22:38:00.000+08:00

There are times when I feel helpless.

When faced with a task that I cannot do, no matter how hard I try.

Sometimes we all need a little help, but we may not know where to find help.

And asking for help just seems so difficult.

But whatever it is, just think of the patients.

First do no harm.

Traumatised

2007-03-02T22:37:00.000+08:00

Approval

2007-03-01T20:53:00.000+08:00

Con: So Dr Leow, when are you all changing over?

Leow: on the 5th, Monday sir.

Con: You know you are welcome to stay on if you like.

Leow: ... ... Erm, Thank you sir.

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Didn't know if it sounded like a compliment but I think I'll take it as one. Anything to make my day a happier one is good.

Working Sick

2007-02-26T21:12:00.000+08:00

Even though it's been acknowledged that if one falls sick, one should not be working. But even then, I hardly take MC when I'm sick.

In fact, I continue to work even in times of flu and fever.

Because sometimes I know, if I am resting, someone else is suffering.

Maybe it's bad for the patient, spreading germs and bugs around, but I really don't see how I can take MC and be comfortable resting at home.

Sian ah

2007-02-25T20:09:00.000+08:00

I've been feeling quite in the dumps lately, ever since the CNY.

Can't quite put a finger on what's the cause.

But just can't help but feel that everyday is just a passing day.

Routine, mundane and boring.

No mood to do anything else, just feeling tired and very lethargic.

Doesn't help that I get a headache every few days and is down with the perennial flu.

Ah... Sian ah...

What's my limit?

2007-02-19T10:12:00.000+08:00

A recent article in a local daily states that the optimal number of patients to doctors is envisioned at 1:1.
(And as we currently fall at 2 patients : 1 doctor, we are encouraging the influx of more foreign doctors)

As an individual, I wondered how many patients can I handle comfortably without acknowledging that maybe patient care is compromised at some point.

As most healthcare departments work in teams at the moment, we must consider that if the team consists of 2 SCon, 1 Con, 1 ACon, 1 Reg, 2 MOs and 1 HO; there should be 8 patients x 2 =16 patients for the HO to manage. (which is really quite a bit)

Of course some will say16 patients is not a lot, but it really takes 1 ill patient to keep you busy.

Having worked in teams with >50 patients and also in teams with <10 patients, I've felt that any number up to 16 is a realistic number that I can stretch myself to, before I start feeling that I'm not giving my best care to every patient in my care.

Of course, some patients need more attention than others. And having the help of an MO , especially with an ill patient is invaluable.

Routine changes are expected, it's the unexpected sudden urgent changes that can turn the whole day from a normal peaceful day to a 'oh my god, it's bad' day.

What's my limit? Is it too low?

Sigh

2007-02-15T20:57:00.000+08:00

P: What is this blood for?

D: It's for tumor markers.

P: Oh.. I did this before in the clinic. So if it's high, it means it's recurred right?

D: It was quite a while since you last had this test.

P: I hope it's low.

D: We hope so too.

P: Okay, thanks doc.

D: ... ...

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Knowing that the scan showed liver mets. This conversation was emotionally difficult.
I do not know how to break the news to him. Just hoping to take things a step at a time.

No easy way to learn

2007-02-12T20:15:00.000+08:00

Con: So Dr Leow, I hope you are learning.

L: Yes I am sir.

Con: A lot of people just do things without thinking, I hope you are thinking.

L: Yes I am sir.

Con: That's the hardest part of teaching. Teaching people to think.

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"We would never learn to be brave and patient if there were only joy in this world."
- Helen Keller -

Johnny Clerker

2007-02-06T20:02:00.000+08:00

After clerking multiple elective cases, clinic admissions and A&E admissions for days, the Johnny Walker slogan keeps coming to my mind.

"Keep Clerking."

The Hospital

2007-01-25T22:07:00.000+08:00

Recently I've been watching this taiwan drama. So far the first 6 episodes has been pretty good, touching on the issues of ethics both in patient care and in work; and also about the politics of the hospital beauracracy.

Although the resus scenes do not quite adhere to ACLS guidelines (CPR for VT?), but it doesn't really bother me, besides I think the cast is good-looking enough to distract me from all that.

"I swear to fulfill, to the best of my ability and judgment, this covenant: Make the care of my patient my first concern; listen to patients and respect their views; recognize the limits of my professional competence; be honest and trustworthy; make sure that my personal beliefs do not prejudice my patients’ care; avoid abusing my position as a doctor; and work with colleague in the ways that best serve patients’ interest."

Omnipresent iPhone

2007-01-22T20:57:00.000+08:00

Enjoy the good times, while they last

2007-01-17T20:51:00.000+08:00

I believe there's a cycle in everything.

Like the seasons, if there's warm days; there'll be equally cool days.

Likewise in our lives, if we have good days; there'll be equally bad days.

So enjoy the good days while they last, because bad days may be just around the corner.

sabishii desu

2007-01-15T17:49:00.000+08:00

Miss

You

Resolutions

2007-01-14T17:04:00.000+08:00

It's a bit late, but better late than never.

Save up more money for our future.
Start studying.
Get fit, again.
Pick up a new sport.
Bring my family out for more dinners.
Go on a really long overseas trip.
Be more proactive!

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And I hate the rain!

Actionable Intelligence

2007-01-13T19:33:00.000+08:00

Over morning coffee with my team, my consultant talked on the topic of actionable intelligence.

Actionable intelligence is the quest for knowledge or information which will make on impact on the management of the patient.

Information which does not alter the management of the patient is useless and should not be actively sought for.

Whereas information which will change the management, should be sought out and acted upon.

ie. Patient has had a total thyroidectomy. The serum calcium levels was done immediately post-op and was low. However patient is totally asymptomatic. Do you act on the result and replace calcium?

If the calcium levels was normal, but the patient exhibited signs of hypocalcemia. Do you not treat?

If the answer is no, why do we do the serum calcium? Why don't we just examine the patient clinically?

Is the serum calcium levels immediately post-op indicative of the actual calcium levels? And if it is not, why do we still take serum calcium post-op immediately?

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Don't worry if you are confused. I was confused when I heard it too. But it does provoke thought.

And sometimes I feel that the line between just investigating for the relevant problem and treating it VS investigating widely and ending up with a multitude of new problems is really thin.

And treading on that line is tough and needs experience.

Believe it or not! Slack lining is a real sport!

Learning Rounds

2007-01-11T21:10:00.000+08:00

I enjoy learning during rounds.

Whereby the consultant / senior doctor asks clinical questions specific and directed to the patient we are managing.

It makes knowledge easier to remember and that much more interesting than reading it in a textbook.

Does that make me a clinician?

I'm always happy when I learn something during rounds. And therefore I was pleasantly surprised and pleased when my registrar took time to teach during rounds.

It seldom happened during my last posting, which everyday felt like a routine.

And I don't think it's a waste of time, or something that can only be done when time is a luxury.

In fact, by teaching during rounds; important points in the management of the patient is highlighted and this ensures that the HO watches out for these points in the management of the patient.

Which, ultimately is good for the patient, and the team, and of course the HO.

Surgical emergencies

2007-01-10T22:13:00.000+08:00

Everything in surgery is an emergency.

In fact, I believe the 2 words are synonymous.

I'm a lot more careful in managing GS patients as there are so much more ill.

There are like time-bombs, an emergency could happen anytime.

SVT secondary to sepsis
Sudden massive melena
Septic shock
Right pleural effusion resulting in desaturation
Perforated viscus presenting as air under diaphragm

All these are just a preview of the cases I've had to deal with in the last week.

Everyday when I go to work, I'm afraid.

Afraid of what emergency I will encounter again.

Sure, it's a good feeling when your patient pulls through because of your timely intervention, but somehow I feel that as long as they are in the ward, anything can still happen.

And therefore I'm happiest when discharging patients.

Future

2007-01-09T21:42:00.000+08:00

Just barely a week into the new posting and I'm not enjoying it very much. Sure the workload is lighter than in CGH ortho, but I worry about stepping on unknown landmines.

And with very ill patients everywhere, an emergency is just waiting to happen.

If I ask myself now, "Do I want to do surgery?"
The answer will be "No."

But when I ask myself, "Am I confident I don't like surgery?"
I don't know that answer myself.

Maybe I need more time as an MO to experience surgery. Maybe I just don't hate medicine that much to say I want to do surgery.

I still remember a senior doctor I really respect saying, "The most complete doctor is a surgeon, because he can do both medicine and surgery."

And his little prep talk on his specialty has got me considering about it as well.

And I really want to be as complete a doctor as I can.

4 more months to go. A limitless future lies in wait. But what lies in wait? I really don't kn0w.

Familiar-Unfamiliar

2007-01-03T21:00:00.000+08:00

Welcome back!

Last Day

2007-01-02T19:10:00.000+08:00

Picking up my bag and getting ready to leave the house for my last call / day was sentimental.
At least I knew I won't be taking service27 for the next 4 months.

Wearing the oversized and drab baju was nostalgic. Will I ever need to wear it again? Remembering the countless hours that I spent roving the wards in that suit, and how sometimes I wished they had more pockets and was more fitting.

There were good times and also bad times in that department. But I'm glad to say there's definitely more good times. Although a small department, it's like a small family. Will miss the free biscuits and coffee, and the sumptous pharmaceutical-sponsored lunches.

Stepping into the cold HO2 room, I realised I spent a lot of time here. Being on call 7-8 times per month definitely isn't fun, and it does strain on me physically, mentally and spiritually. With the late dinners with the team and sometimes the occasional NBM when admissions skyrocket, every call has been a great learning experience.

And finally the team list, which the HO's life revolves around. I will miss the patients, which I trust will be in good hands after the changeover. I will also miss the nurses who have helped em learn along the way. Really wanted to take photos with them ( but too shy lar).

A new beginning, a new start. But with that much more experience.

Moving on

2006-12-27T20:52:00.000+08:00

5 things I hate about Ortho

There's just too many calls per month
Everyday is the same. Doing changes non-stop.
I really don't learn much academic stuff.
Referring to too many other disciplines.

5 things I like about Ortho

Doing backslabs make me happy. Doing traction makes me happier!
Managing a patient's medical problem on my own.
Good nurses who aid in my work.
Patients who appreciate my hard work.
Seeing patients get better after a fracture.

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I'm in a love-hate mood.

With the current workload, I can't wait to change posting. Just imagine 4 calls/month in SGH GS.

But then again, the people in CGH ortho are quite nice.

Haiz, 2 more calls to go. They better be good. I'm starting to tire.

Just came; Now gone

2006-12-24T15:28:00.000+08:00

My annual leave just started this Tuesday, and now it's ended. Good times really flies.

But amidst the rainy days and occasional sunrays, I've managed to fulfill some pre-leave must-do-stuff.

Getting some much needed rest, especially since the weather makes it so inconducive to go out.

Get a makeover, of sorts. Went on a shopping spree. Only regret is, I could have spent more.

Win some moolah at mahjong.

Discovered karaoke is expensive during festive periods but went for it anyway.

And stayed at a really really nice local hotel. And really lived the high life, for a weekend.
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But as with all holidays, I didn't manage to do the following:

Clean my room
Get new working clothes
Spend more time with my family (it's never enough)
Go climbing
Lose weight, tone up (it's always harder during the hols)
Read up

I've so got to do those before the new year comes.

Morbidity & Mortality

2006-12-18T15:27:00.000+08:00

The Death Test

According to our research, you'll be dead by January 2065 at age 82
- probable cause -> heart attack
YOU DIE: 82.3 years

AVERAGE MALE LIFE SPAN:
72.5 years
As you can plainly see, you have more health & vitality than the average man.

You have 21249.8 days left on this earth.
You've already lived 29% of your life.

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Flu-filled Christmas

2006-12-17T07:01:00.000+08:00

Got the flu bug, seems like everybody's getting it.

And being on call with watery eyes and runny nose is really horrible.

Luckily it was a good call.

Thanks to those who offered me tissues, or asked if I've been crying.

It's just the flu.

Quiz 3/3

2006-12-15T19:07:00.000+08:00

The Slow Dancer

Deliberate Gentle Love Dreamer (DGLDm)

Steady, reliable, and cradling her tenderly. Take a deep breath, and let it out real easy...you are The Slow Dancer.

Your focus is love, not sex, and for your age, you have average experience. But you're a great, thoughtful guy, and your love life improves every year. There's also a powerful elimination process working in your favor: most Playboy types get stuck raising unwanted kids before you even begin settling down. The women left over will be hot and yours.

Your ideal woman is someone intimate, intelligent, and very supportive.

While you're not exactly the life of the party, you do thrive in small groups of smart people. Your circle of friends is extra tight and it's HIGHLY likely they're just like you. You appreciate symmetry in relationships.

ALWAYS AVOID: The Battleaxe

CONSIDER: The Maid of Honor or The Sonnet

Practicality

2006-12-14T21:42:00.000+08:00

This posting has been quite an experience of its own.

Not that it has been fun the whole time, although it has been mostly enjoyable; but rather that this posting has been more of a hands-on posting than academic posting.

In terms of orthopaedic knowledge, I don't think I've amassed much more knowledge than I started the posting with.

But in terms of picking up practical skills, I'll probably never forget how to do a backslab or straight leg traction ever.

Now if only I got to scrub up to do something more major...

Quiz 2/3

2006-12-13T18:47:00.000+08:00

Nearing the end

2006-12-12T19:07:00.000+08:00

The new year is just round the corner. With the new year also means the end of another HO posting.

I still remember the last time I changed posting. I really missed the department and hospital and everyone who have touched a part of my life.

And I had such a tough time settling into the new environment.

But almost 4 months down the road, I'm beginnning to feel a sense of deja vu again.

I'm beginning to feel that I'll miss everyone in CGH, from the senior doctors to the nurses to the allied health staff.

Christmas gets me into the emotional mood...

Quiz 1/3

2006-12-11T18:39:00.000+08:00

You are The Hermit

Prudence, Caution, Deliberation.

The Hermit points to all things hidden, such as knowledge and inspiration,hidden enemies. The illumination is from within, and retirement from participation in current events.

The Hermit is a card of introspection, analysis and, well, virginity. You do not desire to socialize; the card indicates, instead, a desire for peace and solitude. You prefer to take the time to think, organize, ruminate, take stock. There may be feelings of frustration and discontent but these feelings eventually lead to enlightenment, illumination, clarity.

The Hermit represents a wise, inspirational person, friend, teacher, therapist. This a person who can shine a light on things that were previously mysterious and confusing.

What Tarot Card are You?
Take the Test to Find Out.

Frustration

2006-12-10T21:04:00.000+08:00

Dammit! I'm a doctor, NOT a plug setter!

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I'm suffering from call fatigue again.
There comes a time when the phone rings too many times.
I was this close to screaming my head off if another call comes in to ask me to set a plug.

I just need to vent.
I just need a break.

How I have changed

2006-11-30T15:06:00.000+08:00

Almost 1/2 year down the HO road, I retook the Medical Specialty Aptitude test:

Rank /Specialty
1 pathology
2 hematology
3 colon & rectal surgery
4 dermatology
5 endocrinology
6 neurology
7 allergy & immunology
8 radiation oncology
9 rheumatology
10 gastroenterology
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What a far cry from my previous attempts when I was a medical student.
29th Dec 2005

Looks like I may spend my life looking down the microscope...

The List

2006-11-26T22:00:00.000+08:00

In the surgical disciplines, the 'list' is the most important thing in the world.

At least for the houseman.

The 'list' is the first thing I see when I come to work and the last thing I do when I go off work.

Everything I do revolves around the 'list'.

And the aim of the house officer is to make sure everything on the 'list' is done, every patient on the 'list' is well taken care off.

And that the 'list' is short. Or as short as can be.

And that's when the MOs start saying that discharge planning is very important.

So we work hard and try to shorten the 'list' as much as we can. And when the list is sub-ten, we look at it with pride.

But come take-day, and the 'list' will be long again. The depressed look on the houseman is indicative of how long the 'list' is.

Almost like building a sandcastle, all the efforts will disappear when the waves come in.

We just have to enjoy building sandcastles over and over again.

A ramble in the woods

2006-11-19T23:14:00.000+08:00

I seen to have lost the drive to exercise. Maybe it's the fatigue after coming back from work. Maybe there's no motivation to exercise anymore.

Nightcalls have been pretty bad these few weeks. Admission rates have been high and I've already broken my Ortho PB twice this month.

Have been surfing the net and coming across funny yet useless stuff. I really should spend more time studying or reading up on more serious stuff.

Chritmas is coming, really feel like going out but I've been on call the past few weekends. I really need a breather.

It really is time for a holiday. It's time for me to spend a little time on myself, for myself.

Solving the career dilemma

2006-11-11T22:25:00.000+08:00

An epiphany just dawned on me a couple of days ago.

The solution to an age-old question revealed itself suddenly.

I've been pondering hard about this question recently too.

And receiving the letter for cluster confirmation made me think about it harder.

Which broad specialty should I go into? AKA Surgical or Medical or Public Health?
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The answer to that question lies in how you think about this event.

Imagine the event of a chicken crossing the road.

Now, what is the first question that comes to your mind?

1) Why did the chicken cross the road?

2) How did the chicken get across the road?

3) Why in the world am I reading this?

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If you are (1), you are probably Medical. You want to know the etiology and treat the root cause.

If you are (2), you are Surgical. You don't care why. You just want to know how to do it so that you can just do it.

If you are (3), you are meant for Public Health. You are realistic enough to know that there are better things to do in life than devoting your whole life to Medicine.

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Disclaimer: This entry represents the inane random thoughts of the author and is not meant to ridicule or criticise any profession or persons.

Routine

2006-11-07T21:17:00.000+08:00

I haven't been blogging much recently.

There just isn't much to blog about.

Work has been more routine than extraordinary. Maybe that isn't all too bad, but I don't feel intellectually stimulated enough. Somehow this posting has not been very academic and after weeks of work, I still feel that my orthopaedic knowledge has not really increased much, although I can make a pretty good backslab now.

Private life on the other hand, has taken new dimensions and with it exciting prospects and the inevitable worries and planning.

Sports has taken a bad seat, although I'm up for the Standard Chartered run this December, I haven't been training enough. Blame it on the multiple nightcalls, which totally wrecks my training schedules.

My consultant said, "We should learn to not just treat the symptom but the cause." I have been keeping that phrase in my head, and have been spending more effort in my care for the patients. Finding myself more and more medically-phillic and surgically-phobic.

Missing all my CG mates. Really haven't seen each other for ages. Wasn't so bad in SGH, as half of them were in medicine. Anyone read this, please message me so we can try to organise a outing.

Halfway through. Hanging in there.

2006-11-01T20:15:00.000+08:00

Laughter as medicine

I can always count on this to perk me up.

Cause and effect

2006-10-30T21:17:00.000+08:00

Every symptom has a cause.

Some symptoms can be treated symptomatically:
Cough - Procodin
Runny nose - Loratidine
Giddiness - Stemetil
MSK pain - NSAIDs
SOB - oxygen

But that should not be the end of treatment.

Every symptom has a cause.
And trying to find the cause is the harder and more important thing to do.

1) Symptom -> Differentials (history, physical, investigate and trace!) + symptomatic relief
2) Monitor
3) Diagnosis -> Confirm (reassess patient) + start treatment

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I need to improve. Half a year of HO-ship has gone, I still stand by the opinion that HOs are overworked and undertrained.
We are not merely glorified clerks and we definitely do not go from glorified clerks to clinical doctors overnight.

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I haven't been happy at work recently. Feeling more like a slave than a doctor. Rushing against time everyday. It hasn't been enjoyable.

And I've never stuck long at anything I don't enjoy.

Where do I go from here? Considering I have a 5-year bond to go, I really need to find THE passion in work. Maybe it's the routine-ness of this posting. Maybe it's the unexpected crap you can get sometimes. Maybe being a single HO in the team is mentally and physically tiring.

Maybe I'm just not the surgical type.

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If I don't enjoy orthopaedics now, will I enjoy doing sports medicine?

Seriously considering geriatric medicine. But then the grass on the other side is always greener.

Wish I had a more medical senior to consult with now, unfortunately there's none now.

Research? Sounds like a good option, but I know nuts about it.

Teaching? Maybe when I'm much older and more established in my practice.

Administration? Just read an article about medically trained administrators, sounds like a interesting option but I do like seeing patients clinically.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6 more months to go. Counting down is so painful.

Quotes

2006-10-28T06:43:00.000+08:00

“All men make mistakes, but only wise men learn from their mistakes.”
~ Winston Churchill ~

“Anyone who has never made a mistake has never tried anything new.”
~ Albert Einstein ~

“Experience is the name every one gives to their mistakes.”
~ Oscar Wilde ~

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Life Path 3

2006-10-20T12:31:00.000+08:00

Your life path number is 3 - [Life Path 3 (3, 12/3, 21,/3, 30/3)]

The Life Path 3 indicates that you entered this plane with a strong sense of creativity and with wonderful communication skills. Achievement for you most likely comes through engaging your ingenious expression. A truly gifted 3 possesses the most exceptional innovative skills, normally in the verbal realm, writing, speaking, acting, or similar endeavors. Here we are apt to find the entertainers of the world, bright, effervescent, sparkling people with very optimistic attitudes. The bright side of this path stresses harmony, beauty and pleasures; of sharing your inventive talents with the world. Capturing your capability in creative self-expression is the highest level of attainment for this life path.

Life is generally lived to the fullest, often without much worry about tomorrow. You are not very good at handling money because of a general lack of concern about it. You spend it when you have it and don't when you don't.

The 3 loves connecting with people. The characteristics of the 3 are warmth and friendliness, a good conversationalist, social and open. A good talker both from the standpoint of being a delight to listen to, but even more importantly, one who has the ability to listen to others. Accordingly, the life path 3 produces individuals who are always a welcome addition to any social situation and know how to make others feel at home. The approach to life tends to be exceedingly positive. Your disposition is almost surely sunny and openhearted. A happy and often inspired person, you are constantly seeking and needing the stimuli of similar people.

There is a remote side to your 3 Life Path, as well. This comes as a surprise to the native and to those who think they are well acquainted. The 3 is actually a very sensitive soul. When hurt, you can easily retreat to a shell of morose silence for extended periods. Nonetheless, the 3 eventually copes with all of the many setbacks that occur in life and readily bounces back for more. It is usually easy for you to deal with problems because you can freely admit the existence of problems without letting them get you down for too long. Because of your own sensitivity to hurt, you have a caring disposition and seem to be very conscious of other people's feelings and emotions.

In romance, the 3 is a very ardent and loyal lover. Affairs that don't go well can leave scares that seem to linger. Emotional experiences of all sorts tend to deeply touch the 3 and the drama may take some time to play out. Regrettably, the giving disposition of the 3 often attracts demanding partners. As with most of life's issues for the 3 Life Path, balance in relationships is illusive.

Your big test with a 3 Life Path is controlling your highs and lows. You won't survive very well in any routine environment or when you are placed under dominating management. Slow thinking and overly contemplative people tend to frustrate you, and you don't function too well with this type whether you are working for, with, or under them. Your exuberant nature can take you far, especially if you are ever able to focus your energies and talents.

For the few living on the negative side of this Life Path, a 3 may be so delighted with the joy of living that the life becomes frivolous and superficial. You may scatter your abilities and express little sense of purpose. The 3 can be an enigma, for no apparent reason you may become moody and tend to retreat. Escapist tendencies are not uncommon with the 3 life path, and you find it very hard to settle into one place or one position. Guard against being critical of others, impatient, intolerant, or overly optimistic.

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Got this from some insurance website which offered free horoscopes consultation.

I've always thought my lucky number was 4.

And for those who know me, I'm not terribly creative.

Well, at least they got the part about the poor financial sense right.

I'm a sensitive and loyal lover!

Grin

2006-10-19T20:05:00.000+08:00

Just caught the finals of the National Science Challenge and watched RI blitz-ed VJC (IP) and HCI in the final round.

Coming from below by 3points to win by13points in the end is just awesome.

How come I wasn't as smart when I was their age?

House MD

2006-10-15T17:53:00.000+08:00

House Parody

For all the fans of House MD, like me. Even though I think that this parody doesn't do House justice. It does seem to hit the nail on the head in terms of the direction of most episodes.

Planning for the future

2006-10-15T17:26:00.000+08:00

It's so hard planning for the future.

Thinking of how to invest money, grow money.
Thinking of when to buy that first car, house.
Thinking of what career path to take.

Now I know why the term quarter-life crisis was coined.

It's such a far cry from the little decisions I took last time.

Like what colour shirt to wear?
Like how far should I run today?
Like what fast-food should I eat today?

Big decisions that can affect my life in its entirety and have long-lasting consequences require a long time to ponder. But sometimes even after pondering for ages, I still find it hard to decide.

Some say, it's time to try everything when one is young.
Some say, if you don't get burned, you won't know what's right.

Does that mean I should just make a decision rashly? Just whack it and see where the ball goes?

I really don't know.

The rhythm of the night

2006-10-12T19:10:00.000+08:00

I'm getting my rhythm back. Surviving the EOD call on Monday and Wednesday, I've found myself enjoying it, actually.

Really.

From clerking the numerous cases that come it and preparing them for operation, to managing the desaturations and hypotensions. I found myself practicing better medicine.

And there in lies the satisfaction.

No more feelings of frustration or flustering around. With good accuracy rate in bloods and plugs, I'm getting my work done fast.

It's taken quite some time to get my rhythm, I guess having that Bali break may have helped.

Sure hope I don't lose it.

Back to the Work

2006-10-07T17:46:00.000+08:00

Back from Bali, Land of the Gods. Where the sunsets are glorious, the waves are calming and the wind is refreshing.

And back to work. Where the call room stinks, the work is neverending and the view of the sunset from the ward is just so depressing.

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Random thoughts:

1) I enjoyed Bali. It was a good break, both mentally and physically. (Will upload more photos onto Flickr) Couldn't have asked for a better first overseas trip since after the MBBS.

2) Congrats bro! When will you have your own "xing xing"?

3) Sunburn feels so bad.

4) I've got 3 calls next week with an EOD call. Yikes!

5) Did you know Indonesia is the 3rd largest software piracy country in the world?

6) I thought I may have saw a TRALI in my patient, but apparently it's APO secondary to NSTEMI.

7) Haiz...

Vacation

2006-09-26T20:22:00.000+08:00

Bali awaits!

The Call Syndrome

2006-09-20T21:14:00.000+08:00

~ This is a new medical entity. A never-been described phenomenon ~

It's easy to tell if someone is going on nightcall. One can tell by looking at the person.

Note the following:

The perpetual frown
The furrowed eyebrows
The unkempt hair, which will only become more untidy after the call
The oily skin (only me lah), which is directly proportional to the level of busy-ness
The glasses (no one wears contacts for calls)

The following can be summarised as the pre-call facies, or known colloquially as the 'sian one half' look.

Other than the pre-call facies, the HO will experience the following symptoms:

Depressed mood
Anhedonia
Suicidal intentions (this is a sign of severe disease)
Irritability (especially with ineptness) and inpatience
Muscle fatigue
Tachycardia
Gastric pains (especially when meals are skipped)
Oligouria (secondary to poor intake)

The call syndrome can be categorised into different severities:

It is commonly categorised using the visual analog scale.

The face on the extreme left indicates: mild disease (whereby you get 5hrs of sleep and woken up twice for panadol)

The face on the extreme right indicates: severe disease (whereby the phone does not stop ringing and you have not stopped working - a fair indicator is also when the phone battery falls from 5 bars to 1 bar)

NB: As an experiment: do send in your photos of your call facies to wqleow@gmail.com. I will do a visual analog scoring and predict the busy-ness of your call, for free.

Spinal Nursing

2006-09-17T18:44:00.000+08:00

Spinal Nursing:

2 days
5 patients
3 hospitals
1 doctor

OMG SN

2006-09-14T20:14:00.000+08:00

Phone rings while Dr is trying to set a plug...

~fumbles in pocket for phone~

Dr: Hello?

SN: Dr Lioew?

~sighs in exasperation~

Dr: Yes?

SN: The patient needs an ultrasound, someone wrote here that the radiologist has agreed to do the ultrasound.

Dr: The ultrasound report is on the file, I put it there myself.

SN: Oh, you put the report... The patient went for ultrasound already. Ahh... okay okay.

Dr: Humph...

~hangs up phone~

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If anybody was puzzled by the above conversation, it's understandable.

Working with SN who doesn't know what's happening to the patients can be extremely tiring and frustrating even.

And I've been getting a multitude of calls like that for the past 2 weeks.

Oh my gawd!

Transition Phase

2006-09-13T20:32:00.000+08:00

"... the transition phase is always painful."

I couldn't agree with that statement more. And I thought hospitals in the same clusters would have similar work processes. Well, I thought wrong.

The last week, (hmm, even this week), has been tough. Not only in terms of coping with the different type of work (medical VS surgical), the different teams (luckily I got a nice team but a horrible list) and also the different nurses.

It difficult being in the new environment, and having to find out where the alcohol swabs are kept. (If I have difficulty finding swabs, you can imagine the problems I face trying to find other stuff).

It has also been trying, especially not being able to go post-call. In fact, I can't even go post-call on time (ie 5pm), instead I can only leave at 6-7pm. That means I'm chronically short on sleep, and that is not fun at all, I can assure you that.

But like any transition phases, it's a short-term thing. Today I finally felt more settled in but I suspect it may take a bit longer before I start to really enjoy the posting.

But at least I'm starting to know my patients and how to manage them. I'm more in tune with the team and every person's nuances. But there's always room for improvement.

So keep working!

Musings of an Orthopod HO

2006-09-10T09:04:00.000+08:00

1) The list is really long...

2) Morning rounds are lightening fast.

3) Discharge planning is very important.

4) I hate it when the team is on take.

5) Every scan is urgent.

6) The nightcalls seem better, at least the passive ones.

7) I have a nice team.

8) It was nice doing my first backslab.

Ortho (surgical) VS Medical...

I'm still not used to the change.

Overwhelmed

2006-09-05T21:29:00.000+08:00

Too overwhelmed to talk......

Gagged

2006-09-04T22:01:00.000+08:00

A gag order has been given by a higher authority.

Entries with a non-medical theme may be the norm soon.

......

Change and Inspire

2006-09-03T00:30:00.000+08:00

Just as I thought I was getting used to this lifestyle, change happens.

Change is always harder if the present situation is rosy.

But change is inevitable and facing difficulties can make a person better.

Sometimes there's no point thinking about it. It's better to just get it on.

Thank you for the memories, I will always bring them with me.

And another inspiring quote for the next posting.

KIV Home soon

2006-08-29T20:05:00.000+08:00

The hospital is a dirty place.

Not that it is physically dirty with rubbish and litter, although sometimes the MO room is just that; but that it is full of germs (bacteria, viruses and fungi).

And these are not your typical common flora, these are 'commando-trained' bugs that will make you very very ill.

MRSA
VRE
VISA (not your American Express)

There are so resistant that a new term was coined for them - "Nosocomial".

And when your doctor says you can go home, please go home. Because the last thing we want to do is to treat a nosocomial infection.

And trust us, sometimes treatment CAN continue at home.

A non-medical entry...finally

2006-08-25T18:28:00.000+08:00

4 months have passed since HOship started. Looking back, it seemed like time flashed by. But I can still remember how excruciatingly slow time passed by when the day was bad.

Almost all my time during these 4 months was occupied by work, sleep and food. I work almost everyday including weekends, except for my measly 1 week leave which I spent time doing my presentations anyway. I sleep post-work hours, trying to catch up on lost sleep. And I eat to stay alive and continue working.

All work and no play makes Wei Qiang a dull person. There's really nothing else to talk about, except how difficult that plug was or how the patient kept complaining cannot pass urine even when he's on a catheter.

I can so count the number of minutes I spent doing anything else other than work, sleep or eat.

Thursdays soccer with the guys at SGH.

Weekly jogs in preparation of the Standard Chartered run this December.

And the occasion climb, during my leave, where I destress and get pumped.

Maybe there is life outside of medicine, but it sure is limited.

Involved

2006-08-24T21:49:00.000+08:00

The more involved I am in my patient's condition, the more I worry when I go off work.

Even at home, I think about how they are doing, especially the acutely ill ones.

Sometimes I wonder whether I will see them tomorrow morning.

So when I walk into the ward, I glance at the beds to see if my patients are still there.

And when my area of coverage has more ill patients than I can manage (which happens to be any number more than zero), I find myself feeling very vunerable.

I worry that any tardiness or wrong move on my part could potentially mean life or death for the patient.

That is mentally stressful.

Karma

2006-08-23T15:09:00.000+08:00

It's been a long time since I've talked about any serious issues.

During this month at my current ward posting, I've been allowed to almost fully manage the patient with minimal supervision.

Not that I'm so good that the consultant lets me loose, but more of a lack of manpower, resulting in 'less supervision'.

As I've mentioned in other entries, this places a tremendous amount of mental stress on me as I have to consider all aspects of the patient (history, physicals, investigations, social and nursing care issues) and have a plan ready to present to my consultant.

It is unlike other departments whereby our senior's make much of the decisions and we just carry out the changes.

As doctors, we treat and help patients. A consultant once said, "1/3 of patients will live no matter what you do, 1/3 will die no matter what is done and the last 1/3 will survive based on the treatment we give."

Some patients will deteriorate, and I always ask myself if I could have done more for this patient.

What if the patient belonged to the group whereby my treatment matters and I did not manage her adequately?

Is that harm to patient? How do I know the patient doesn't belong to the group that will deteriorate despite treatment?

If I did not do my best? Wouldn't that be harming the patient?

So instead of saving lives, I'm doing the opposite.

I dread to think so. I really hope I'm not. And so I always ask my seniors when in doubt.

Sometimes it amazes me how they can eyeball a patient and immediately tell if the patient is going to make it.

Clinical acumen? I wish I had it, because it's really useful.

Want

2006-08-16T20:24:00.000+08:00

There's a shoe that I want to get.

Problem is I can't find it in Singapore!

Muesli Man

2006-08-10T00:44:00.000+08:00

Doing a nightcall is tough, and therefore there must be adequate equipment to ensure you survive the night with minimal fuss and maximum sleep.

The essentials of a night call include:

Your name tag and stamp. You will really want to be identifiable as the on-call and not some doctor who has decided to stay back late. You will also be asked to make several entries during the night on how patient refused blood taking or medicines.

Your handphone will not stop ringing, so make sure you have a full charge before you start. Have a piece of paper to write all the cases and passives now. Prepare two pieces if you are feeling unlucky. Have at least 2 pens because looking for a pen in the middle of the night is really frustrating.

You will need your stethoscope, no doubt. A watch is useful. And I always carry my little life-saving pouch.

It's life-saving because it contains coins which I will need to buy drinks from the vending machine at 2am to quench my parched lips. It has money for me to grab my dinner. It also has the important 'gerald tan' drug lists. A torch should be carried around because looking for one wastes precious sleep time. And I always carry butterfly needles bacause it can mean half hour of venepuncture on a patient or 3 minutes, thus ensuring you get 27 minutes of sleep.

And most importantly, you need food.

I always carry muesli bars around, you don't see it here because I've finished them. A happy doctor is a well fed one.

Breaking Bad News

2006-08-06T20:28:00.000+08:00

When someone comes in for something as innocuous as low back pain and eventually gets diagnosed as metastatic cancer, you will suddenly feel that life has grabbed you by the neck and flung you down mercilessly into a bottomless pit.

It was so unexpected, so unpredictable, so sudden.

And how do you break such news to the patient, when all this time, he/she thinks it was just low back pain.

How can we deal with the torrent of emotions that will pour forth after breaking the news, or even the lack of emotions.

Denial, Anger, Bargaining, Depression, Acceptance

How do we deal with each stage?

Favours

2006-08-02T21:47:00.000+08:00

In my time at SGH medicine, I have received help from many friends / colleagues and likewise have tried to return such favours or rendered help when needed.

It is indeed fortunate to be able to help than be helped.

But when you receive help, be grateful and remember to return the favour.

So in view of creating a cohesive work environment, please 'pay it forward' the next time you have the chance to help someone.

Who knows? You may receive some help too.

* Thanks Oriana. I owe you a big one. *

Call Fatigue

2006-07-26T22:00:00.000+08:00

There comes a point in time whereby I start to feel that night calls are just too tiring and that life would be so much better without calls.

Yes, I know I used to say that night calls were the best learning experience ever. But sometimes we just get so tired, we don't learn anything.

And call fatigue can be dangerous, especially for the patient.

- Imagine being super tired, with 5 new cases waiting to be clerked, 20 plugs and bloods to take and only 1 hour left before you have to start your ward round.
- The nurse shoves an ECG in front of you and says, "Dr, note ECG." You take a glance at it, especially the ECG interpretation and you sign because it's doesn't say normal sinus rhythm.
- You see some ST changes but can't quite make out the significance with your tired blurring eyes.
- Your mind screams, "Sign the ECG and get out!" and you do so accordingly.
- You just missed an AMI.

In my opinion, calls should be limited to maximum once a week. And we should be on call only with the wards we can working in the day. This ensures that the patient receives continuity of care. But the limitation of manpower prevents us from doing that.

And rostering me for 7 calls next month is just plain torture. I'm complaining to the SPCH (society of prevention of cruelty to HOs).

SIP memories

2006-07-24T22:00:00.000+08:00

SIP students are here! Reinforcements have arrived!

Sure brings back memories of when I was a student.

*December 2005 SIP entries
*November 2005 SIP entries

The types of medical students

2006-07-21T21:14:00.000+08:00

Which type were you?

* from http://theunderweardrawer.homestead.com/scutmonkey.html *

Beauracracy in the hospital

2006-07-20T21:16:00.000+08:00

The hospital is one big maze.

Like a maze, it takes many turns to get from one place to another.
ie. Many people are needed to get a single thing done. Organizing a urgent scan requires an urgent form, talking to the staff nurse at the radiology room, talking to the radiologist, the porter who sends the patient down etc.

Like a maze, it has many dead ends.
ie. Fierce radiologists who scold you, sending down the radiological form after 5pm requires calling.

Like a mouse, we have to learn to know the maze and its dead ends and to avoid them.

If not we won't be able to get our cheese.

Countdown

2006-07-18T19:47:00.000+08:00

Counting down is painful and almost intolerable.

It keeps me constantly on my edge, making me unable to relax when I want to.

It irritates my nerves, with the constant reminder that time is ticking on.

Argh!

Annual Leave

2006-07-14T21:58:00.000+08:00

Why do we have leave?

Because we need to rest.

Because life is not just all work and no play.

Because we need the time to reflect, and to ponder on what we have done so far and how well we have been doing it.

But that's easy to say, but hard to do.

How do we know if we have done well or bad?

We need a inner mirror. Someone or something to compare, like an international scale of measure.

Who can give us that?

The good, the bad and the average

2006-07-11T20:31:00.000+08:00

Some days are good.

ie. All your patients are stable and well. Your MO is helping you with your changes. Your consultant is in a good mood. The nurses help you with the bloods.

Some days are bad.

ie. All your patients are dangerously ill. Your MO is post-call. Your consultant's temper is short. And the nurses ask you to do a thousand and one things.

And some days just fall in between.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Why can't all the days be average?

I would trade in all my good days for the bad days to go away.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Audrey thinks we should look at it from the other angle.

A good day is boring and nothing is learnt.

A bad day can be useful as it gives one valuable experience.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
What are your thoughts?

Convocation

2006-07-07T23:19:00.000+08:00

A medical student's life is not complete without the convocation. Likewise the house officer's life has not began without convocation.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Here are the much awaited convo photos.

My dad can't wait to try out his new Panasonic Lumix camera which sells at $799, which he got at $399 because it was a display set.

You may notice that yours truly has a perpetual frown on his face. This phenomemon is the 'House Officer's Scowl' and is caused by many bad work days. The treatment for this is leave.

My lame attempt at posing.

Found some friends before the ceremony started.

Incidentally I was asked to do an live interview whereby it will be screened before the ceremony. Now I know how I look like on the projecter screen.

And, metaphorically speaking: my 5 years of medical studies can be summed up in this moment. The feeling of achievement when I put on the gown, when I receive the scroll, when I see my parents and their unspoken pride and also when I see my friends whom we have gone through thick and thin together. All in 5 seconds.

Post Convo Euphoria

2006-07-07T20:11:00.000+08:00

The CG guys who weren't on call or post-call. We made it!

CG8899. Yes I came up with the name. It's a long story. You guys were a great bunch to work with. Really missed you guys since work started.

The overworked SGH medicine bunch.

Using the staircase asthetically.

My parents!

HO / MO

2006-07-04T21:56:00.000+08:00

When does one become an MO?

MO.
Is it a just a position one automatically fills in when you've completed your Ho-ship or is it a position that you occupy because you have the capabilities od performing MO tasks?

Can one be both proficient in being an HO and also an MO?

I'm trying to be more involved in the care of my patients but completing the HO tasks leaves me with little time to learn my cases.

Honestly I get a wee bit frustrated for not being able to do both.

But then again, I really like the feeling of having someone senior looking out for you. It's good when I know that the patients are always being looked out for.

Having an MO is definitely better than not having one. Period.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
On the phone, I always introduce myself as HO.

But sometimes I realise some don't like to talk to HOs.

It's like a lack of respect, some say.

Do people want a MO to speak to them because MOs are better?

Or that they just want to speak to someone else of higher seniority?

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Heart Attack

2006-06-30T15:27:00.000+08:00

Ever played the card game 'Heart Attack"?

It's a game whereby players will take turns to open cards and if the same 2 matching cards open consecutively, the first person to shout 'Heart Attack" wins.

It's a game whereby you have to keep your eyes peeled and be on the lookout for it.

Likewise in the medico-sphere, especially during night calls, you have to keep your eyes peeled and be on the lookout for it.

Yes, for heart attack.

Because like the card game, it has the tendancy to pop up any minute.

Saviour

2006-06-28T20:52:00.000+08:00

Prof has re-ignited my passion in medicine.

Observing him during morning rounds, pondering his train of thought and management plans have made me more interested than ever.

And his clinical acumen is unfallible.

As the Chinese saying goes: "The old ginger is always the spiciest."

Presentation

2006-06-27T22:22:00.000+08:00

Receiving a call from the secretary informing you that you have to present in 3 days' time is not good news.

Preparing for the presentation over the only Sunday that you are off the whole month is saddening.

But at the end when I look at my slides, I'm happy and feel a sense of achievement.

When somebody comments and says it was a good presentation, I feel life is good again.

Broken Spirit

2006-06-16T17:53:00.000+08:00

It's been so mentally draining recently.
I'm beginning to have self-doubt over my abilities to be a capable doctor.
Doesn't help that I don't get any encouragement.

Right now I don't really want to do medicine.
Because it's just too tiring.
And when I'm so tired, I really don't feel like helping people.

My temper is short, my mood is foul, my face is in a perpetual frown.
I don't enjoy what I do.

What a stark contrast to my first month.
When I was tired but happy, doing what I did, helping patients.
It's not where you are, it's who you are with.

A New Start

2006-06-12T12:05:00.000+08:00

7 / 6 / 2006

2006-06-07T16:01:00.000+08:00

"We all make mistakes. The most important thing is to learn from them."

I need to reflect on my actions, my work.
I have been far too busy to sit down and think.

"We don't make mistakes. Because when we do, patients die."

If my actions caused harm to any patient, I would be guilty forever.
Even my death would not atone me.

Random Thoughts

2006-06-05T20:54:00.000+08:00

1) I need a life. Thank god I took leave this month.

2) How do you learn when you are busy? If your mind is jammed with the results of your patients, you don't have space to ask what are the symptoms of meliodosis.

3) Work is never finished.

4) How can you evenly distribute work, making everybody happy?

5) Gosh, who's going to cover me when I go on leave?

6) I'm down with a sore throat, must be because of that old lady coughing in my face while I was trying to set a plug on her for 1 hour during my nightcall.

7) World cup is coming up! Go Italy!

8) Hmm... I need a haircut.

9) I'm going to sleep...

Tekan

2006-06-02T22:18:00.000+08:00

A consultant once said to us, " You should know how to be a house officer when you are a medical student. When you are a house officer, you should know how to be a medical officer."

People don't change overnight. Neither do one wake up the next day and suddenly knows how to be a medical officer.

The only way to to take up more responsibility as a house officer. To be able to manage a patient wholly on your own with minimal supervision from your consultant is the aim.

Wish me luck.

Changeover

2006-05-31T21:05:00.000+08:00

Just when I thought I was getting used to it, change happens.

Change is difficult.

But difficulty builds character.

Never closes

2006-05-30T20:49:00.000+08:00

SGH is the only hospital in Singapore that never shuts its doors even when all the beds are filled up.

That means there'll always be new cases to clerk, always.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I remember my previous MO said there used to be a commadarie in the past.

Whereby the HOs on call would try to help each other, especially when their call is lighter.

I think that's very nice, and a practice we should try to keep up.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Being on call is like a lucky draw.

You start off the call in anticipation of a trying call, especially when you are either HO 1, 2, 4.

Sometimes, you get really unlucky and the load knocks you off your feet.

Sometimes you get lucky and manage to rest your butt on the red armchair in your call room.

So, do you feel lucky today?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Being on call is like going to war.

Every call is like a battle, you go in without knowing if you'll survive or not.

But when you see the morning sun, you know you will make it.