Is Medicine the one?

"Boss, our house officer examined this patient yesterday, and diagnosed a rectal tumour on rectal examination." my Registrar said.

"Did you confirm it?" said my Consultant.

"Yes." he replied

"Excellent job Michelle!" my Consultant said with a big smile.

It felt great diagnosing a cancer with my bare hands, even though that meant bad news for the patient. My Registrar trusts my history and examination a lot, and I could have imagined the disaster if I made a misdiagnosis which could have been overlooked.

Having being diagnosed with cancer because of my examination, the patient wasn't pleased, especially with me. I don't think I was at fault for causing him to have such bad news broken to him. In fact, I think I've done him a lot of good, because at least we can treat him appropriately. Doesn't matter if he doesn't like seeing me, or isn't friendly to me.

My Registrar had a bet with me about whether I got my diagnosis right, and I won the bet, so as promised, he owes me a lunch treat.

"Want to operate on patients today even though u're on call?" he asked.

I was excited. It's not my first time operating, and even though it's not a major operation, I was still excited. Every operation feels like a new experience for me.

It was a wound debridement and drainage of an extremely huge haematoma. Not a major operation, but a really bloody one. We had to cut a very huge piece of skin out, and it was quite gross to be honest. Dearie would have puked if he was around...hahaha.

After the op, my Registrar took me to the coffee room..

Him: You will be a good surgeon.

Me: SURGEON?! I don't even go to theatre much. I don't intend to do Surgery. I want to become a physician...

Him: I can tell whether u have the make of it. At least u didn't have any reaction with that operation when it's so bloody. Anyway, regardless of whether u're doing Surgery or Medicine, u will be good. Why do you want to become a physician?

Me: I like to see patients as a whole. I like to see a wide range of things. I want to be able to treat many different diseases if I do voluntary projects when I'm more experienced.

Him: U'll just be a hindrance when u go to the villages because the village healthcare professionals could be even better than a doctor because they've been living in the village for a long time and have seen thousands of the same cases there. They can treat the patients even though they're not properly trained in Medicine. When u're there, u might even find yourself being useless and causing confusion. And physicians don't actually know about every system, in fact, Surgeons know more about every system than them.

Me: Really? Doesn't look like it..

Him: Before you operate on the patient, u have to consider the different systems of the body. U must have a reasonable knowledge of the condition of every system before putting the patient onto the operating table. Physicians become too specialised these days, so if you're a Cardiologist, chances are you'll not know anything much about the other systems.

Me: That's true...now u're making me wonder if my choice is right...

Him: Have a think. Choose something you like. If you want to make a difference, become an opthalmologist. Go to the villages and remove cataracts. It's a very satisfying feeling when you allow a poor villager to regain his eyesight, and allow them to see the world again and see who is the doctor who cured them.

Me: I did think about that. But if I were to do ophthalmology, then I won't know any other systems..

Him: That's the problem. U will become deskilled in everything else apart from the eyes.

Me: That's not what I want. Will an Internist be the one?

Him: An Internist knows every system and they are good at handling acute cases, regardless of what system. But if it gets too complicated, they will still end up referring to another department like the Cardiologist. But you can become an Internist and learn to do sophisticated tests. Take your time, Michelle. Do something you love. That's most important.

Sigh..his words got me thinking. I do like Medicine, but I am also aware that it's not an easy specialty because very often there is more than one system to take care of, especially in adult medicine. Things can get very complicated, and polypharmacy adds to the complications.

I know what I want to do with my life. And till today, I am still holding tightly to my dream and aiming for it. I want to make a difference to those who are genuinely ill yet deprived of treatment. And I want to do a specialty which will allow me to do so, but Medicine these days are so specialised. U choose one, and u get deskilled in another. How do I become an all-rounder? How can I be reasonably skilled in every specialty? I am not aiming to become a leading expert in everything, but at least I want to reach a level almost comparable to a specialist. I want to do various invasive investigations, and sophisticated tests. Is this ever possible? How long will all this take?

Sometimes, I wonder if my dreams are realistic. From the looks of it, it doesn't sound realistic, and Grandaunt thinks I'm still living in my world of idealism. But I am refusing to accept what's being seen as "realistic" by others. I don't know if it's due to stubborness, but I want to hold hopes that a dream can turn into reality. I don't want to tell myself that things cannot happen when I haven't tried, and decades down the road, find someone who has proven me wrong and leaving me with deep regret and self-reproach about my unwillingness to make the said impossible possible.

When I think about the above, I feel selfish as a person too. A person like me shouldn't even have been in a relationship, and shouldn't ever be in one too. I am so keen and determined to realise my dream, that I'm doing it at the expense of others. At times, I think I don't think Dearie deserves me and sometimes, I feel unfit to even say I love him. And for all the pain that I'm putting him through, the more guilt I get.

I've been selfish for insisting that I am going no where else except to train myself properly at home. And I'm insistent on proper training because I want to realise my dream. As a result, Dearie has to try and compromise by finding ways to move to Singapore, and end up having major arguments with his Dad.

Suddenly, I feel like a great sinner..

Medical Notes

Shall share some funny stuffs I read today...these were actual things written in medical notes...

1. Exam of genitalia (private parts) reveals that he is circus sized (gosh..how huge is that?!)

2. The skin is moist and dry (????)

3. Rectal exam revealed a normal size thyroid (wah...if it reaches the rectum ever...it should be in the Guiness Book of World Record..manz..his neck must be really strong to hold that weight)

4. She stated that she had been constipated for most of her life until 1989 when she got a divorce (hahahaaha.....marriage related..)

5. Patient was in his usual state of good health until his airplane ran out of gas and crashed

6. Patient lives at home with mother, father and pet turtle who is presently enrolled in day care 3 times a week (goodness! even pets get pet-sitting?!)

7. Bleeding started in the rectal area and continued all the way to Los Angeles (how much blood does the patient have??!)

8. While in the emergency room, she was examined, X-rated and sent home (hahahahah)

9. Patient was alert and unresponsive (meaning?)

10. When she fainted, her eyes rolled around the room

11. She has no rigors or shaking chills, but her husband states she was very hot in bed last night (WAH!!!!)

12. On the 2nd day, the knee was better, and on the 3rd day it disappeared (Oh knee..where are u?)

13. Patient has been depressed since she began seeing me in 1993 (clearly the patient doesn't like seeing u....lol)

14. The patient refused autopsy (duh?! why would any alive ass want an autopsy?)

15. Patient left white blood cells at another hospital (hahahaa...must be super prone of infections now...nil immunity)

16. Both breasts are equal and reactive to light and accomodation (hahaha...i would like to see how the boobs react to light...do they shun?)

17. Skin: somewhat pale but present (wouldn't it scare u to see a skinless patient?)

18. Patient has 2 teenage children, but no other abnormalities (so it's abnormal to have 2 teens at home?)

19. The lab test indicated abnormal lover function (gosh..we're in a really advanced era..do bring ur better half for a lab test)


*****For all I know, I might be one of those people who wrote one of the above down without realising...*********


Got more things to blog abt, but just had a short chat with Dearie which didn't turn out well. He's very very very sad after a major argument with his dad. Somehow, I know something isn't right..but he said he'll talk to me abt it another day. I think I can roughly guess.

Shopping Spree

I dragged myself out of my accomodation today. I need some fresh air, and basically, do anything to allow myself to unwind.

I decided to dye my hair, and give myself a really good hair treatment, so off I headed to town. But tmd...all the angmo salons told me that I need a skin test before colouring my hair, and I can only colour my hair if I don't get a skin reaction after 48 hrs -.-

First time I heard of such insane things. Typical of UK isn't it? Full of crap. It's just frustrating to get anything done in this place. I mean, where on earth in Singapore will u find a salon telling u that u need a skin test? The customer will walk out straight away and go somewhere else to do it manz! If I've got sensitive skin, then I will think it makes sense for me to have a skin test. But I started colouring my hair since 19, and have no problems so far. And if they're so worried that I will get a skin reaction, then maybe they should also tell me I need a skin test if I just wanna have a hair wash cos for all I know, I might even have a reaction to the shampoo. *rolls eyes*

Anyway, I'm getting out of this country soon...so I won't have to tolerate anymore crap this place has.

Thought I'll head to the Chinese salon in Cardiff instead. But damn it...they're fully booked..grrrr. By the way, the salons in UK are weird...they actually charge money if u want to blow dry your hair!??!?!?! It just doesn't make any sense to have your customers walking out with wet hair right? But apparently, some angmos here do that to save money. Odd people. And the charges...typically 20+ pounds (SGD 60+) for blow dry ONLY. BLOW DRY! If I open a salon and only do blow dry for 10 pounds, I'll earn shit loads manz. The only tools I need are combs and a miserable hair dryer.

Got quite pissed anyway for being unable to do something simple for myself. So I decided to do some shopping instead. As usual, couldn't get any nice clothes (mostly kiam chai). Accessories did catch my eyes, but I didn't buy them cos it was too expensive. Sigh..

"I shall give myself a pamper" I told myself, and shooed off to Boots (this place never lets me down! love it!). Bought numerous things...

1. Cotton facial pads
2. Sanctuary Spa Salt Scrub
3. Vo5 Hot Oil
4. Vo5 Intense Masque
5. Boots 3 minute mask
6. Loreal De-maq expert Elixir Concentrate Ultra Make-up Remover

And also a nice big bag I happened to see in T.K Maxx :)

I tried most of the products I bought today, and I'm really pleased with my buys.

The Hot Oil's pretty good. It doesn't leave an oily feel to my hair, and it has indeed softened my hair a lot. I'm quite a fan of Alberto Vo5. Their products in the UK seem to please me a lot, but for some strange reason, the ones in Singapore aren't that good even though the brand is the same.

The Sanctuary Spa Salt Scrub impressed me! It was really a S.C.R.U.B, unlike the normal body scrub in tubes. Apparently, this product is an award winning one, having been voted the Best Body Scrub by some magazine in the UK. The impressing part was when I rinsed off the scrub from my body, because the skin felt sooooooo smooth, all thanks to the very very thin layer of jojoba oil. The oil layer is still on my skin and I love the smoothness it gives. Shall let my skin slowly absorb it :)

The make-up remover was great too. Love how smooth it feels on my face as it removes the make up I had on today. It cleanses off my waterproof mascara well too. And after washing off the make up remover, the skin felt very smooth and the skin tone was lovely too...fair with pink cheeks (obviously...it doesn't last for hours)!

The 3-minute mask felt nice too. It's got cucumber extract, so it's suppose to soothe the skin. I've got the cloth masks, but I don't really like them very much because I've got combination skin, and the cloth masks which are very mosturising tend to leave my forehead feeling oily while the other parts supple and mosturised. It's too expensive to do put on cloth masks regularly too, so I decided to buy one which will allow me to use a few times a week.

Well..actually I'm doing all these because I'm going home soon, and I don't want my parents to see me looking haggard. I've lost a lot of weight after I started working, and because I haven't been eating well, I do look very haggard and tired at the moment. Am hoping to do mini miracles on myself at the last minute now.

Another reason is because I'm stressed abt seeing Dearie. Yes, he only went home 1 month ago, but I'm sure he'll notice changes when he sees me again if I have lost even more weight. I haven't seen his Mum for more than a year, and I don't want her to see me looking so worn out.

I'm starting to feel stressed about my clothes now. I don't know what to wear to China. I know I don't have much of a choice since my clothes are all old. But I do hope that at least I look decent enough to go out with Dearie there. I am always feeling inferior whenever he takes me out because there are many girls in Beijing who are fashionable, whereas I'm just a plain jane. I keep thinking I'm an embarrassment to Dearie. Dearie said if I put on make up, then I will look different even though I'm not wearing any new clothes....hmm...I guess I'll make sure I put on make up everyday there.

I should be feeling excited to see him..but each time I am making a trip to China...my heart feels heavy...and it feels heavier now because of the current problems...

Emergency call

"One of your patients has deteriorated suddenly! Can u come here now? It's urgent!!!" said the nurse.

I rushed down immediately to find my Registrar, other colleagues and numerous nurses around the patient. There was my patient being breathless, and looking poorly.

"Look for M. She has the information about what to do." said my Registrar. Off I went to look for M in the Treatment room, finding her on the phone with the microbiologist.

The moment M saw me, she was planning her escape. "I can't handle this microbiologist. I don't understand the antibiotic regimes he's giving me. Can u do it?" she said. And before I could even reply, she said "I have never done these before. I don't even know what tests he's talking about. Do u know?" I quickly glanced through the list. I knew there was no delay, since things have to be done NOW before the patient gets transferred urgently to the High Dependency Unit.

"Ok. Tell me all about this patient and what info u have been given so far." I said.

Briefly she told me about the patient, and hastily, she threw me a sheet of paper with all the urgent investigations instructed by the Consultant and the Consultant microbiologist.

I grabbed all the medical supplies I needed, including all the forms and labels, and hurried to the patient's bedside, with my panicky colleague behind me.

Another fellow colleague of mine was there too. "R u alright?" I asked. "Errr...I have done one blood culture. But there is a list of things to do and I don't know what some of them are." said the other colleague.

In my mind, I had a clear idea of what I needed, and without any delay, I did all the investigations which was required to be sent off urgently. I knew my colleague was in a fluster because she started messing up the bottles despite me labelling them. And before I knew it, both of them silently sneaked out, leaving me all alone to handle the patient. I didn't realise it until the nurses said, "Your colleagues have left u to fight the war yourself." when I went "Can someone pass me a gauze?"

I guess the situation during then was too intense for me to feel pissed. I am surprised by the calmness I had while handling the entire situation myself. I carefully put labels onto the bottles, organised my forms nicely, placed the appropriate bottles together with the forms, and then sent them off urgently. I also gave the nurses instructions about what else they needed to do, before I contacted the microbiologist.

He gave me advice on which antibiotics to administer, all of which I wrote clearly on a piece of paper. My Consultant then turned up, "Hey Mich! What's the situation like now?"

"Under control. I have done all the investigations wanted by Dr H. And he gave me the antibiotics regime. If you're comfortable with it, we can start the treatment." I said.

"Ok. No problem." he said.

Just when the problems are solved, then came my colleague..."How? How? U spoke to Dr H?"

"Yes. It's all done." I said.

Knowing how panicky a person I am, I was quite amazed by how calm I was throughout the emergency situation. Today's experience has boosted my confidence a little. But I definitely don't feel pleased abt my colleagues who just ran off. I can accept the fact that there are some things which they may not know (I dont think I know everything either), but at least I would expect them to stay and watch, instead of saying "Oh, I don't know how to do this. U do it." and then shoo off. For all u know, the same situation might happen tomorrow! And I can understand that Dr H can be super long winded, and sometimes he gives too much info that u will find problems concentrating, but that doesn't mean that u just throw it to a colleague halfway and wash your hands off. If u don't understand, ASK!

Honestly, the things instructed by the Consultants weren't over the top. They weren't invasive things like urgent lumbar puncture or pleural taps. They were very simple things, and I don't think I would have saved the patient's life immediately by carrying all those urgent investigations, but as junior doctors, it is our responsibility to carry out the simplest procedures and it's also the least we can do for ill patients. In fact, I felt quite bad about myself when my Consultant helped put in a venflon into the patient when I was prescribing medications. He was smiling when he looked at me, but still, I do feel bad.

Anyway, today's situation taught me the importance of being calm. I have been thrown in tense situations before, and I do admit that I did panic, and I was full of admiration of the Registrar when he so calmly approached the situation.

I remember once when I came out of the ward, feeling lousy about myself because I was in quite a bit of panic while the medical Registrars and surgical Registrars were resuscitating a patient who was basically vomiting copious amount of fresh blood continously. As I was walking down the hospital corridor with my Registrar...

Me: I feel lousy about myself. How do u maintain your calmness?

Him: U do know what to do. Remember ABC. If u make sure each of them is done, then u have done all u can for the patient. Whether he survives or not, it's not within your control anymore. Keep telling yourself that, and u will be calm."

I do aspire to be like that one day. And I'll work towards it.

A couple who loves each other dearly, but having to undergo parental disapproval........sounds like that of a typical film. Each time I watch films like this, I am filled with admiration for the couple and am terribly touched by the love they have for each other. Looks good on screen, and sounds brilliant when told, but it's hell being in it.

I had never expected myself to be in such a situation, and I can only say it's full of agony being in it. Since Dearie left, I have spent more nights crying to sleep than not. Sometimes, I feel so mentally drained that I'll even skip all my meals for the day, and spend my day sleeping.

Feelings between me and Dearie have grown, and along with it, the pain grows. The more disapproval we got, the stronger our feelings grow for each other, and so does the pain. And what drains me are the reasons why his dad is against our relationship. It isn't my fault that I'm not born and bred in China. It also isn't my fault that I'm not blessed with the height and good looks.

It is bad enough having to be separated and to see each other every few months, but everything has just gotten worse with things that happen because of disapproval.

First, it was arguments between father and son. Then came allowance cuts. Then came more arguments and Dearie got so fed up with it all that he chose to move out of his Dad's to live with his Mum.

Then now Dearie's car is confiscated, hence resulting in him having to take the public bus (he can't even afford the taxi now). And even the keys to his apartment is confiscated.

What else is going to happen next, I ask myself and Dearie. Will Dearie be forced to work in China and forced to go for matchmaking sessions with his dad's friends' daughters?

I can understand that Dearie is feeling very stressed over these at the moment, but what he said just now hurt me tremendously.

I don't deny that I hope to have a rich boyfriend, but that isn't the reason why I liked him in the first place. I hope to have Dearie picking me up from the airport with his car, not because I want to be chauffered around to prove that I have a rich boyfriend, but because I love car rides, and sitting next to my bf and looking around while he drives is one of the things I hope to experience with the person I love. Staying with only Dearie in his apartment was because I hope to spend quality time with him, with no disturbances. Having been together for more than 2 years, it's a shame that we rarely have time for ourselves without any worries/disturbances. I miss the time when we were in Sichuan together, and if it weren't for his good friend who so kindly had a 30 minute shower just to give us private time, we wouldn't even have the chance to even kiss and hug each other to sleep. I want to experience that again.

But I didn't know that my requests were too much. I wasn't aware that his car has been confiscated, and neither was I aware that the key was confiscated too. And when I'm feeling disappointed enough, he had to say I'm making life difficult for him.

Maybe my parents are right. I shouldn't even go to China this time. I am indeed going with a very heavy heart this time, but for the sake of seeing Dearie, I told them I'll cope and still chose to go ahead with the trip (am I being silly?).

He started comparing me with his cousin. Apparently, she's in love with a guy who is extremely poor and her parents are hitting the roof top over their relationship. But his cousin doesn't give a damn abt it, and told Dearie that in the worst situation, she'll leave home to marry the guy and live the rest of her life with him in the village.

"I was touched by what she said, and I asked myself if u love me as much as how she loves her boyfriend. If it were u, will u move out of the house and live the rest of your life with me in the village? U wouldn't. U aren't a girl who will go through hardship with me. U can't lead a hard life. If I weren't rich, u won't choose to stay with me. U're the same as the girls in Beijing."

After being together for more than 2 years, this is what he makes out of me. I'm not rich, but neither am I that poor to desperately need a rich bf. Neither do I have to make myself go through all this, when I could go back to Singapore and meet someone else who is from Singapore, who can afford to marry me, who can afford to give me a comfortable life.

Suddenly, it feels pointless to continue with this relationship.

献给我的第一封情诗

昨天，我读了献给我的第一封情诗。。

“你会写诗吗？”
“你喜欢？！？！ 你怎么那么土啊？”
“土吗？我喜欢男生写诗给我。” ：）

我是一个很奇怪的女生。我的完美约会是和我喜欢的人一起去看歌舞剧，看芭蕾舞。我喜欢男生写中文诗给我。记得我刚和陈光交往的时候，第一次好好打扮，和他一起去看歌舞剧，当时感到特别幸福的我，一边微笑着，一边流着眼泪。那种快乐没法形容，因为这是我梦寐以求的完美约会。

因为爱着他，就会不停地想和他拥有很多很多的“第一次”。也就因为这样，我很希望他能成为写第一首诗给我的男生。他并不是一个浪漫的人，所以自然而然，就觉得我很土，偏偏希望他能写诗给我。其实在现实的生活中，情诗已经越来越少见了，而且也会让很多人觉得特别肉麻，可是我却很喜欢。我喜欢语言能力很强的男生，喜欢能用笔带出语言美的男生。我喜欢一个一个字的去理解它，喜欢幻想。

“只怕到时我真得写了，你看不懂！”
“你又知道？我中文不是很好，但也不至于那么差。”

我以为他不会写诗给我，随着时间，也就慢慢的忘了这件事。

可是，昨天他忽然发了一首他亲笔写给我的诗：

“
君属南，吾属北，
逢君在天北，
情深似海，
本想与君归，
怎奈缘分太凄美，
空流泪，
现只盼来年风花雪月时，
与君长相会

-光-
”

短短的一首诗，我看完了之后，眼泪一直不停地流。我特别感动，却也很难过， 因为我很清楚他是以什么心情来写出这首诗。

今天我在医院也写了一首向他回复的诗。 这是我第一次写诗，并不容易，尤其是我中文并不是很好。不知道他看了会有什么反应，是大笑还是感动呢？

“
吾属南， 君属北，
分隔两地，却不悔，
只怪自己生不在北
情越深，心越沉，
为何这段恋情如此悲，
日夜思念，以泪入眠，
盼着与君长相随

-玲-
”

Insecurity of a Junior Doctor

Being 6 months into the job, I cannot deny that I have learnt things not found in the textbook, and sometimes even being able to share them with my seniors. But the amount of knowledge I've gained at work is definitely way below my expectations, which clearly brings in a lot of insecurity.

I have sat down numerous times, having deep thoughts about trying to figure out what the priority is for me as a junior doctor. I am allowing myself to have ambitious hopes, but also reminding myself that these ambitious thoughts should stay as thoughts for the time being, and I should focus and try to lay a good foundation for my basics first.

I spent time thinking about what these basics are, and have been trying to place emphasis on them. These included mastering my history taking skills, improving my practical skills, drafting a reasonable list of differential diagnoses, and coming up with basic management plans. I know the above sounds very like the priorities of a medical student, but to me, these are the most fundamental skills. I cannot see how I can allow myself to move on to a higher level if I am unable to master these.

I must admit that I have improved very much in the above. I haven't got my diagnoses right 100% all the time, but I think that is reasonable as long as I don't miss a critical diagnosis like myocardial infarction for a patient admitting with chest pain. But I am thinking very much more than when I was a student.

I have begun to appreciate a patient as a whole more and more, and have started to see how one thing can link to another. This resulted in my improved history taking skills, because rather than turning tooooo focussed on a history, I started understanding the nature of the current problem, and am able to fish out even more information just by digging into relevant past medical/surgical histories. By doing these, it also made me realise that I am starting to see the importance and understanding how patients are managed years down the line for certain illnesses. History taking no longer became some chore which I hated whilst my days as a medical student. And even though I don't deny that it can be a pain sometimes since history taking is time-consuming especially when u've got tons of other ward jobs to do and being haunted every few minutes by the nurses, history has somewhat become a beauty I am starting to appreciate.

A Consultant I once met during my first few days of medical school said, "Ask yourself. Do you enjoy taking histories? If u don't, then u r in the wrong profession, because the history is the foundation in Medicine, and it will be something u'll find yourself doing for the rest of your life in the career, regardless of which level of the hierachy you are in. If you don't have the history, you have nothing." I used to think he was bullshitting, and hated taking histories. As a medical student, I curse each time I turn up at the wards to have the doctors in the team I'm attached to giving me a few names, and then get me to bugger off, asking me to take histories from patients. I also felt that something must be wrong with these doctors because Consultants, especially, are obsessed with getting us to clerk patients. I really really hated it, because...

1. It's boring
2. Just one of those excuses to get rid of me
3. What's the point of making me take them and then not going through it with me?

I couldn't see the importance and the valuable lessons I could gain from this boring task then, and thinking back now, I feel silly. Never did I also expect myself to enjoy history taking now.

It gives me a tremendous sense of satisfaction when a few Registrars commented that I take brilliant histories. Many times, they have watched me take the history before the patient to save time asking them again and I do see improvements - from having to supplement it with numerous questions after I've done the history when I was a medical student, to having almost no questions to ask to clarify things. I even had a Registrar who said my history taking skills are the best amongst all the junior doctors he knows.

I think there is still room for improvement with regards to my differential diagnoses, but I'm still quite happy with myself for coming up with some and being able to justify them. Management wise...basics are fine I suppose.

Yet, there are still days I ponder abt my insecurities. I think it's all due to a lack of confidence from lack of experience. I am constantly asking myself if I'm up to standard for a house officer, and compare myself with my fellow colleagues. Got a colleague who is extremely knowledgeable, but each time I chat with her, I start questioning if I'm too complacent with the objectives I have set for myself, and if I should be more ambitious. I don't quite agree with what she is doing at times because being the most junior of the lot, we're still under a lot of supervision and we should try to seek advice even if we think our suggestion is reasonable in terms of managing the patient. For example, if I were to suspect pulmonary embolism in a patient which would render a CTPA, I would speak to a Registrar to get approval for my suggestion, and not taking full charge by requesting a CTPA without informing anyone else in my team. Also, if a patient was admitted with abdo pain and the Xrays were normal, I might suggest an ultrasound to be done, but I won't just fill in a form and send the patient for it without informing my seniors.

I don't know if my friend is doing the right thing. Her suggestions are appropriate, and chances are it will be approved, but sometimes, I do feel that being at our level, we're entitled to doing ONLY basic management and have suggestions about further management, not taking full charge. Our seniors are definitely much more experienced and have a greater and deeper knowledge of which investigations are better, and have clearer understandings of the latest management guidelines.

I am comfortable with starting patients on simple medications and simple antibiotics, but I am definitely not comfortable at my level yet to start things like hypertensives without consulting anyone. I will only do things I am confident in, and have a very clear understanding of.

But when I think abt it, am I actually restricting myself from moving forward? My aunt used to tell me "A good house officer is one who knows how to be a safe doctor", and I guess I'm not being comfortable abt taking things into my own hands because of what she said. I told Dad about what I think, and he went "Learn to crawl before u walk. If u're inexperienced but take things into your own hands and get too keen to prove something, no one will teach u anything." Sigh...if only Dad's a doc, then I'll probably feel very much better.

I was with a Registrar I worked with in clinic yesterday, and I was feeling lousy about myself at the end of it because he had asked me many questions which I couldn't answer. I apologised at the end of the session for being poor in my knowledge, and I was expecting him to tell me I'm crap, but instead, he said "U're an excellent house officer. Your knowledge is good, now it's about slowly linking the pieces together."

And another Registrar I knew, who chatted with me in the library said...

Him: U're the best intern I've seen in my many years as a doctor..

Me: HUH?! REALLY?! I think I'm crap!

Him: I can see the potential in u..so don't say that.

Me: How can u see it?

Him: U got the knowledge and most importantly, u got the stamina and determination to keep yourself going. U aren't like many docs here who sit all day and whine without doing their jobs.

Me: I whine a lot too, ya know?

Him: Come on...we all do. All u need now is to find a good place that will train u. U are shining in this place even when no one is giving u very much guidance, so if u go somewhere else where training is excellent, u will shine tremendously.

ME:!!!!!!!

Piangz....that does scare me...didn't know I am seen as having the potential (I can't even see it)... :X

High Dependency Unit or Over Dependency Unit?

Finally, my weekend on call is over! Had enough of RUBBISH this weekend! BAH!

My bleep, as usual, goes off every 10 minutes, and more than 50% came from the High Dependency Unit. They've bleeped me much until I think even if I have serious short term memory, I will NEVER forget their extension number. They not only drove me insane today, but also my Registrar and the medical on call team.

Sorry to say this, but I can no longer tolerate them there. I know that patients there are ill and require more nursing care, hence the term "HIGH dependency unit", but I'm seriously wondering if that has changed into an OVER dependency unit. I cannot imagine how much more nursing care can anyone on earth be given....the attention given to the patients there are even MORE intense than in the INTENSIVE care unit in the hospital where patients are EVEN more ill.

It shocked the hell out of me when I see FOUR nurses being there to take care of a miserable number of 6 patients. That's like 1 nurse to 1 patient. Accounts to why they're so "chi bao mei shi zuo" but to make phone calls all the time to irritate us.

Fair enough if it's clearly something urgent, and being in a HDU nurse, every doctor would expect them to have the BASIC sense of what is REALLY requiring attention and what isn't. Nurses there can't take blood, can't do venflons, can't do anything! Makes me wonder what's the difference between a normal ward nurse and a HDU nurse.

Got a patient admitted there with severe pancreatitis who so unfortunately went into atrial fibrillation after a central line was put into the neck to allow feeding (if he doesn't get fed through the neck...he's basically gonna die of malnutrition). But this patient doesn't have any symptoms, and all his blood pressure and everything is fine. Apparently, this atrial fibrillation doesn't stay 24 hours and reverts back to normal after a while, so when it occurred again today, the nurses bleeped me. I spoke to the Medical team about this, and they kindly came to review the patient and put him on Digoxin which is a drug for atrial fibrillation. Everyone knows that medications don't work instantly and all drugs take time to work. The heart rate came down from 200 to 160 and the nurses bleeped me again, complaining that the rate is still high. It did piss me off because they had bleeped the medics about this, and they have told the nutcases that the medication takes about 4 hours to work, but they still won't pleased, so they bleeped me. I asked them when the medication has been administered, and they told me it's an hour ago. I told them that medications take time to work, and told them the same thing that the medical team told them, BUT STILL THEY WEREN'T PLEASED and decided to bleep my Registrar to ask her, who told them (for the 3rd time) that MEDICATIONS TAKE TIME TO WORK. And I heard they still weren't satisfied, so after ending the call with my Registrar, they went to call the medical team again, who for the 4th time, had to repeat themselves. *rolls eyes*

Then bleeps went off again from the same damn unit about blood results of that same patient to tell me that the white cell counts are high (this patient's got pancreatitis!!!!!!!) and they're concerned. WTF! The white cell count HAS BEEN HIGH SINCE DAY 1, and I have completely no idea what's so surprising about the high white cell count when I already know that there is inflammation going on. U don't need to be a brilliant health professional to know that white cell counts go high in an infection/inflammation!

Then bleeps went off again not long later abt magnesium being low on a patient. I would be extremely concern if it's drastically low, but the nurses started getting all panicky when the magnesium was 0.64 when normal is 0.65. Have completely no idea what's all the panic about.

Seriously, I think that unit is OBSESSED to the point that they either don't use their brains anymore, or they are refusing to use it.

There are only 2 ways to end this insanity and obsession there:

1. Get some doctor to sit there and go no where else to entertain their rubbish 24/7

2. Cut down the number of nurses in that ward


************************************************

Sigh...got a message from Dearie saying that the LV small purse he wanted to surprise me with for V day is sold out, and he's pissed off about it because each time he wants to buy something for me to spring a surprise on me, this happens.

I trust his sincerity in buying me a V day gift, and it's sheer bad luck that this happened. No doubt I'm quite disappointed because I adore that purse very very much and it's something I will definitely use since I have this funny habit of not being willing to carry my wallet unless I carry a handbag (and I would choose not to carry handbags if given a choice, be it in the UK or Singapore). I am so lazy to the extent till I'll stuff dollar notes, coins and 2 cards at most...ALL into my pocket (told u I'm not suited to be a female in the first place). This LV purse will allow me to dump all these "pocket" bits into it, and I might even be able to stuff a key or 2 into it too!
Reason for disappointment isn't because I am not going to get an expensive gift from Dearie. In fact, I've gotten so used to Dearie not celebrating anything with me to the point whereby I'll ponder for a few moments if he's got a screw loose if he mentions wanting to buy me a present or having some celebration with me for wateva reason.

Oh well....shall see when the stock comes in..and perhaps (yah..perhaps!) I might use my own $$$ to buy it for myself. I haven't bought myself anything for getting a job, birthday and CNY. Sometimes I think I deserve a present.

Nightmare weekend

*Warning: Pardon the vulgarities...I'm in a mood, and seriously need to vent*

My weekend on call (farking hell....I still have 12 more hours to go!!!) has been the ultimate nightmare. February is definitely the shit month for my surgical rotation, since I'm on call for so many days continuously.

I hate Surgery to begin with, and it has been so ever since my days in med school. I have NEVER had a good surgical placement, and despite wanting to give Surgery a chance, I still don't fancy it.

I can't wait for ALL my on calls for Surgery to end, and even though I know that going back to Medicine is gonna end up being insane, I rather cope with the medical insanity that the surgical insanity. In short, I just want nothing to do with Surgery for the rest of my life!

Been driven insane 2 days straight of on call (note: there's only TWO surgical people taking care of all the surgical patients in the entire hospital). Reasons...

1. Patients coming in altogether at the same time and nurses bleep u continuously to ask u to hurry up and clerk them (sometimes u wish u had 8 hands and 8 legs...)

2. Venflons! Bloods!!!! Imagine being bleeped every 10 minutes by ONE farking ward to put in a venflon for ONE patient when each time u answer the bleep, u repeat the same "I know abt the venflon" to practically every single nurse on THAT ward!

3. Need bloods done on this patient who is difficult to bleed - I went there, and can't even feel any vein or see any either...it's just dumb to stick a needle in blindly, so I told the nurses to call the anaesthetists (they're the ones with all the tools...worst case...central line), and they didn't....but bleep me endlessly to tell me that the patient needs bloods for the rest of the day (did they not understand English?!)

4. Dose warfarin NOW because nurses want to give medications NOW (how to dose warfarin when I only sent off the bloods 10 mins ago? u expect instant results? warfarin can be given even during dinner time...it's just this nurse being anal by insisting that she wanna give warfarin. sorry babe, i'm not your maid. u do it when i think it's suitable, not the other way round)

5. Bleeped by nurses informing me about amylase result of 100+ in a patient who is known to have pancreatitis with an initial amylase of 4000+ (for what?!)

6. Bleeped by nurses about patient having pain and not relieved by paracetamol, therefore needing stronger analgesia (i have no problems with that, and i'm more than pleased to give verbal orders, but for some fucking dumb reason, only some nurses can take verbal orders, and since the one who was talking to me on the phone isn't the selected "verbal order" nurse of the ward, I had to wait for her to get the "verbal order" nurse to come to the phone and having me to repeat myself all over again)

7. Review a lesion on the elbow and insisting that it MUST be seen today, if not, the nurses will force me to see it tomorrow ( so urgent meh!??!?!?! that bloody thing has been there for 1 week! surely it can wait till Monday!)

8. Change new venflon because it's there for 3 days, and insisting that it's hospital policy (MY FOOT! I'll be extremely surprised if nurses actually go and count how many days the venflon is in the hand when it's there for proper reasons like drug administering, and I'll be extremely IMPRESSED with the doctors who will (i bet u my toes that they won't even bother entertaining rubbish like this) go around the entire hospital to change new venflons (pricking patients..) every 3 days. We all have better things to do)


And the list goes on....it never ends... (imagine having to tell new patients whom u're seeing every 5 minutes "sorry, i'll be back..just going to answer my bleep"....super pissed off)

I don't know if it's just this hospital, or it's NHS as a whole, or is it the same worldwide. I'm really curious and I will find out when I start work in Sg.

Must admit that some nurses are brilliant and they've been a great help, but some.....forget it. I'm not a person who hides how I feel about things, meaning if I'm frustrated..u can tell from my voice. I don't deny that I have a low tolerance for rubbish, but seriously, who wouldn't be frustrated?


And I still have 12 more hours to go......argh!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Missing Dearie

I'm missing Dearie.

I've been feeling blessed these few days because Dearie has been sending me many messages everyday without me asking, and he gets worried if he doesn't receive any replies from me. He's also putting in a lot of effort into our rship by going online to look for me whenever he can, and it makes me really happy seeing him on the webcam smiling.

And I've been seeing him a lot in my dreams these few nights too, and each time it happens, I'll wake up smiling.

Dearie's been going through a lot after his return this time, and I'm truly guilty about it. His relationship with his Dad has deteriorated to quite an extent, resulting in a major allowance cut, having to find his own transport if his uncle borrows his car, less conversations with his Dad, and Dearie has decided to move out from his Dad's and live with his Mum.

"Will u leave me now that I can't afford to give u the best?" he asked. I felt like hugging him after hearing how sad he sounded. It must be difficult for him, especially when he's so used to splurging without having to think at all before. He sounded really down and guilty when he told me that he can't afford to take me for my dream spa and facial sessions in the 5 star hotels and I'll have to be prepared that my trip to China this time will be different from the last. I guess it's understandable. With the limited allowance he's got now, it'll be difficult to buy lots of clothes for me, take me to very posh restaurants for meals, and posh KTV lounges.

Honestly, I'll be lying if I were to say money isn't important to a relationship and that I don't fancy having a rich bf. But after more than 2 yrs together, it's more about feelings than the money now. I love him, and I won't leave him just because he can't afford to give me the luxurious life I want. It's a difficult period for him, and it's my duty to stay and go through it with him...besides...all these happened because of me.

I'm still excited to see him soon, and I'm really contented enough to spend time with him, and have nice, simple meals with him. The situation could have be worse, and I think we should be thanking our lucky stars that at least it isn't the worst yet.

Reunion Dinner

Fine, I know it's not supposed to be called a "Reunion Dinner" because I'm not having dinner with anyone on CNY eve.

But I've kinda got to terms with it, even though I admit it still hurts very slightly.

Had a short, but good supermarketing time with Samya. Thank goodness we went to Tescos yesterday, or else I'll have NO food in the fridge for the new year, and chances are I'm gonna munch on biscuits for 'reunion' dinner'.

I don't have the luxury of having any special CNY goodies or delicacies like abalone this year, but that's life in the UK I guess (farking boring! gosh, i seriously will discourage anyone to come to this country). Plus double suay-ness that I'm not in a big city with chinese shops, but stuck with cows and sheep in the countryside.

Anyway, at least with some veges and microwave food, I'll not be starving on the eve, and I shall just stay contented with what I've got.

Didn't manage to buy any CNY clothes too, which just reminded me that I haven't bought any clothes for CNY at all for the last 6 years!!!! Sometimes I wonder if I'm supposed to be a girl in the first place.

Imagine having to be dragged...yes...DRAGGED to the shops by Mum or boyfriend to buy clothes.

Not forgetting that most guys HATE shopping to the core, especially with their girlfriend, my bf has to force me to go shopping, picks clothes for me, makes me try them on, and if he likes it, sometimes he even buys them for me. And there was never once he gets irritated whilst shopping with me. In fact, I finish shopping and get irritated before he does. I wonder if he thinks it's his good fortune that I'm not a typical girl in that sense (probably not...hahahaa).

Never mind. Shall try and see if I can do some nice shopping when I'm on holiday in Sg and China. I'm sure Dearie will take me shopping :) Oh yes oh yes..Dearie said I'll be staying in his house and we'll have our private "er ren shi jie"..just the 2 of us in the apartment with no disturbances from anyone. A giant bed to sleep on, a clean nice car to sit in and having Dearie to drive me around, enjoying good food, probably a wonderful KTV session in the posh "Gui Bin Lou", and having Dearie to pamper me 24/7. Suddenly, it feels like a honeymoon. I can't wait!!!

And I'll be looking forward to the date he promised.....a belated V day dinner for me. Hope he'll remember. Kekekek...opportunity to make up and dress nicely I hope?

Feeling grateful

"If he loves you, and u still love him, then hang on. Who knows, both of u might really end up together?"

Thanks for the support the both of you have given me. It's consoling to know that during this difficult time, there is still both of u who show deep concern about us, understanding what we're going through, and even supporting our relationship. We were most afraid of further parental disapprovement, but your different view has lifted a lot of load off my mind, calmed my fears and gave me the strength we need to keep things going, and push harder for our future together.

Dad & Mum...thank you.