kweee...... puppy made me a nice pandan chiffon cake ^^

and mebbe i'll make a kimchi chocolate cake this weekend or next??

had yummy sambal belacan beans too! and syu made trifle and bomi made kimchi tuna stew and carina made kimchi pancake .... mmmmm... and annie brought along fruits.... what a food oriented person i am.... fufufu

micro exam tomorrow. waaaah

I saw xanthelasmata for the first time in a patient coming to the pharmacy to buy Panadol. It's hard to not look at it when you're going oooh oooh it's the same as the ones in the textbooks!!

And using the torch for the first time I thought I would check out the insides of my nostrils (hey, it was the puppy that first put the idea in my head when he was doing his CR run!). Then I thought it would be cool to do an arc reflex on my eyes. Never really got around to doing them when I saw the 'hole' in my eye :S! Left iris first. Ho hum ho hum pupil shrank. Right iris next. Hold on. What the heck is this little tear there in the lateral side of my iris??! OR is it?? Shine from all angles. Hm.... there this shadow thingy that changes position like a shadow. The heck? I have a hole in my right iris?? I sense..... freak genes! LOL!

And talking about that, I have finally confirmed that my nanny is the one responsible for my short munted nails. T_T cry...! Gaa... no wonder they were heaps uncomfortable after every time nana chopped them. Gaa.... bad nanny lol!

Me got pot of flowers from puppy too! ^^ Kwee! Me like orange daisies! Me decided roses aren't that bad after all though they look more mysterious than cheerful :)! Kwee! I can't wait to get some sort of semi-permanent place to stay in where I can have at least a pot plant. Hopefully a lemon or an orange plant. Lime would be great too :D!

Got the case history done now. Lauren was so sweet to look it over twice for me, first when it was half done. ^^ Swoon... And now on my project presentation. Hope to get it done within the next few days and then start on micro and maybe have a quick look through path or something. YUS! Aja! Aja!

On the cardioresp run now, four more weeks to go before it's the holidays.... assuming I pass of course *ahem*.... though I'm wondering if I would rather repeat a year than stay back for summer to redo a run?? :S

Halfway through or so through my case history now. The only painful part would be having to look through the papers required to do a critical appraisal or what not. Ugh. I really dislike having to look up papers and what not. Will have to start on the stuff for the presentation soon too otherwise I'm going to die come end of the run.

Gotta study for signs and symptoms test this coming Friday and also for Haematology that is on Thurs. Sigh. I wonder how much Haem has stayed back in my brain since I last finished going through it once? Will have to run through it again.

And the results from Gen Med are back. I've passed the run with .... a pass?? But still, it's a YUS!!! (e just doesn't cut it as cool enough unfortunately). And potential distinction for my case presentation too. Lol!

Haven't seen Dr Epton yet. He was supposed to take us for our cardioresp mentoring session but is away. Sigh. Why can't he be away during the final osce? That would be much much preferable. Hopefully I get the other combo where I won't have to see him in the osce, hah.

While at the pharmacy today I kept itching wanting to use the bp monitor again. I'm still not too happy about my last two readings. Wtf man... my long case patient who just had an MI has a bp waaaay better than mine. People eating McD all the time have bp's that are better too. Perhaps I should have a try on my other arm or listen to my renal vessels? Suddenly I feel like I'm like one of those lollies Carina brings back from Levin where the packaging is great but contains only two instead of the three lollies it's supposed to. Appears ok, but slightly defective. Not that the two lollies are any less yummy though. Heh.

Shit, why am I even worried? I've got about 10+ years before I need to worry about it. Meh.

Today the girls next door had their raya celebration. Yummy. Hah, I got to have delish rendang and lots of other stuff! Nyah nyah nyah to the bola! :P

Geee... was hoping the picture could move.... :(

Performance went... well? Overall the audience loved it though I myself knew where I made mistakes. After the rehearsal where I nearly made a mistake after thinking to myself 'it's the second to last page!', I was reminding the silly noodle to not get distracted. On the day itself that was precisely what it did, 'it's the last page! it's the last page! without mistakes!', and then I nearly stopped wondering what chord was next and then moved to hit what seemed most like it which was one tone lower than what it should have been. Lol. Thinking to myself now, do I want to perform for thanksgiving??

Had to work morning yesterday to cover for someone else. Went to about half past twelve, then caught a ride and went to A's. Barb's then sent me back... to work of course at 3. I was thinking at least this would make up for the lack of hours next week then since I've got acutes. Though it seems like I'll be having to work from six thirty onwards. Darn. But when I was thinking that to myself, I certainly wasn't counting on going up to half past nine. What the heck? Why do people have to see the doctors next door last minute? To hell with their coughs and aches and colds! $%^$#%%#$!! If you can leave it to the last minute then you can wait till tomorrow morning for your medicines! Especially that stupid Asian guy whose script was from two months ago. One lady came in with a five paged script right at 8.29! So can't lock the door because she has to leave again. And then more started coming in from there bearing their scripts. WtF! I can't cash up the till like that?!!! And then after we thought it was almost done, just as K was calling out the last customer the lady who called earlier that afternoon about Tixylix came in. Celaka! You had to wait all afternoon and evening before you come and get the mix for your croupy kid?!! And then the nerve to talk about 'I want colourless this, I want alcoholess that! He might react to those things!'. I don't bloody care if they react or not, just choose, buy, pay! And the nerve, the till was done by then and she had to pay by cash, and not the exact change either! And she was not even apologetic about it, even smiley happy! Cekik dia wanita celaka! And after I readjusted the float and K got everything else straightened out, it was half past nine-ish and I got home close to 10. Sweat.

The only thing that made it more interesting was the fact that the alarm went off at the doctors next door. And K was so worried we were the ones who set it off. Turn out that it was from the alarm from the side of the building furthest away from us and hence was someone else. Wonder if the two security guys caught anyone?? Hah, the morphine, methadone and pseudoephidrine are over at our side silly, not at the doctors!

p/s If you read through my entire rant, I pat you on the back and Beetley bug gives you big hug.

Today was the full dress rehearsal for the cultural night tomorrow. Was feeling so nervous, had to drag pupiaks along so many times just to get some practice at the hospital chapel's piano (poor thing, I'm making him page turner.... he wants to bonk my head with paper in return though :S) but hurrah it went ok during the rehearsal earlier on. So a bit more practice tomorrow maybe at the chapel and the last rehearsal and then it's shows on! Whopee! Can't wait to get it done!

Been thinking if I want to perform at the Thanksgiving service this year as well. Steinway piano up on offer I'm told. Gosh! I really want to, but playing what? And it's in September as well. Do I have enough time to practice and polish whatever pieces up I wonder? Do I still want to perform at the end of year's thingy?

As for the more geeky side of things, I suppose gen med is going ok so far. Can't say this is the best sort of run though. I much rather the short and brief ward rounds of surg than the leg jellying hours long gen med ones. And if I'm that desperate for patient contact then I'll take the less physically active one then. Standing the whole morning for one round is a bit much I say lol. I've done the first patient case history and shall hand it in tomorrow. Thinking if I should skip ward round early and start on my second in the morning, since there's no way I'm going to be really that free during the afternoon. Evening time is certainly out for sure now.

I should really get started some time on the presentation as well I suppose but I'm not motivated. Thinking of getting it done during the upcoming holidays. Lol.

Path these days are consisting mostly of dermatology pictures and slides. Lots of really scary skin lesions and lots of slides made up of cells and keratin. Hard to tell them apart though, but I least I get the general idea - pink cells with dark brownish (?) nuclei everywhere and then weird blue ones occasionally or lobulated nuclei here and there and dead skin bits right on the top. So very medical indeed.

I can't imagine how terrible life must be with psoriasis and all those other skin conditions. That one episode of whatever dermatitis on my neck and legs really made me afraid at one point that my skin would look ugly forever and I remember trying to cover my neck up with scarves and what not most of the time too. And golly that itch! I wonder if that is how scabies must be like as well?? Ugh!

Mummy.... Do you think this would look good on me.... Me want.... Make... Make.... Kweee? ^^

Big fly has been lazy and not been doing much, but at least I've finished the clinical question report. Hopefully I'll finish the presentation slides tonight as well and that will be it. Gather the last bits of data I need tomorrow for the chronic patient report thingy and type it up and that would be the end of it as well. I'll have to start practicing the shoulder and knee exam soon too!

I haven't made challah in a long time now. Was thinking of making some other stuff the other day, but considering how I've got quite a full bottle of yeast still sleeping away in the fridge....

I played some with the black/dark blue eyeshadow and white and silver/gray ones today, on a unwilling pup and my own. I can't quite seem to get it to look right. Most times it looks like I've gotten a semi-black eye almost?? :S Lol. Not that I really want to walk around a goth of course... heh heh *laughs in a high-pitched voice, waving accusations away*

Saw ah jie today. Gaaa.... it's somewhere about 19 weeks?? Erm.. bump noticeable. Not very comfortable. It brings to mind again the article I saw on a childless by choice person's blog some weeks ago. Which then reminds me of the tomato-coloured-screaming-howling-vomit-smelling thing I had to carry earlier in the year which totally freaked me out. Which then reminds me of the scary stories I've ever heard about pain, tears and tears (one is to rip, one is to drip... am I spelling it right??) and needles, and what not... gaaa.... It's almost like pets. It's nice seeing someone elses's pet and playing under safe settings, but there's the safety net of it not being your responsibility.

Thinking further out into women's health in general, after the surg run, after this run, should I be more mindful and check myself for lumps? Should I even bother about smears? Ack. What a hypocrite I'll be.

I need to start being serious about practising my pieces since gen med and cardioresp are coming up. Do I really want to sign up for the performance? Do I? I really miss the adrenaline rush. But greater is my fear of screwing up in front of people I will be meeting for many years still probably.... must do so hard out tomorrow if Rolleston is free morning...

But at the same time I'm thinking of making challah tomorrow... bugger... I need more hours in a day.... should I do it on Monday night then?? Think think think....

Second week of run is over now. I'm not very far on both my assignments for my GP run which is kinda sad when I think about it seeing as I'll have a couple of other things to worry about soon in two weeks plus time. At least I've made some headway which makes me feel slightly better. Not really in the mood to do any work to be honest.

Was on the bus yesterday back from work. No one else besides driver and me. Went to get a seat and then I thought I saw something that looked somewhat like a bag of money, more or less like the one I put into the safe after I cash up the tills after work. I sat down thinking it was probably some dirty handkercheif or something. After a while I got curious (why?? :S) and bent over to get a closer look at it (hoping to see snot??) and what the heck, it WAS a bag of money. Went up to the driver with it, I think I found something and it contains a lot. -_-"' What an intelligent statement now that I think of it. She pulled over, turned round and took a look and said that sure is. Double -_-"'. I either made her day, or we both made some careless guy's day. But as I sat throughout the remainder of the journey, I couldn't help but wonder what I could have done with an extra bit of cash. >.< Does that been any good karma has been negated by those bad thoughts I wonder now?? LOL.

Going over to visit my chronic case patient again tomorrow. She likes apricots. There sure isn't any right now simply because it's the wrong season. Darn. Got her a box of raspberry and peach tea instead. Hopefully that's good enough compensation. :S I personally think peaches, apricots and nectarines all taste the same. Wonder if she'll think so?? Gaaaa... at least I tried ... trying to convince myself here. Lol. And I'm thinking if I should go back and buy another to perfume my cupboard with it. It smells yummy.....

Looking at the sales from last week, for my 11 hours, I made 600+ sales.... but it fell short of the predicted targets. T_T Sad. Oh well. Sometimes I wonder if my weekly five and a half to six hours or so of standing will predispose me to varicose veins... especially when it's a slow day, and even more so when the night before I happen to notice little veins under the thin skin on the sides of my feet.... :S!!

Holidays have started at last. Had made use of the piano at the hospital for practice once so far. Currently working on that sunflower piece. Took me half an hour to work through that first two lines... not that they are particularly hard, just that with all that jumping around it's hard to be very accurate with the aiming.... and blah blah blah excuses for rusty fingers. Gaaaah! More practice is needed which means more trips sometime soon.

Will have to work out soon when to get together with Michy to bake as I had promised. And will have to make some baking as well and then find a good day to visit Mr G. And at the same time drop by Mrs S as well. Perhaps I should pay Margaret a visit as well and maybe show her my 'hairless wonder'. Apart from Margaret, I wonder if visiting the them would actually be ok? Perhaps I do have a soft spot for old people?! :S! Lol. More like I feel bad if I felt like I've used them. Might get the Worm to help me with one of the baking projects that I'm eyeing and maybe use that for the Su's for being so kind at the start of the year. Hurrah for kitchen slaves!

Poor nana was trapped in a hotel room on Nana's day. I wonder if offering to lend my beatley bug out constitutes as uninformed consent now that I think of it. I never asked if that was ok with Beatley buggy. Heh heh. What a bunch of silly words I've picked up. And 'acopia' I would never have known if I wasn't told them by precisely the same people who never wanted them used. Lol.

I've a feeling I need a kick in the butt to get myself started properly on the ethics essay. I've been promising myself I'm going to get it done before the worm comes down, so sign of that happening yet. -_-"'!

Will have to tell the worm too that she'll have to either spend one night with her buttey, or drop by the pharmacy to get the keys off me to let herself in, or drop in after 9pm .... hm.... hm....

Right, I feel like hugging my beatley bug now so that's all for now. Kweeee~

Saw tofu patties that A brought to school for lunch the other day that her mum had made for her. Immediately the greedy porker I was remembered grandma's 'protein balls' made of tofu. Mmmm. Must have some. But patties would certainly make it more portable for school lunches. So bus-ed out to Kosco just to get the tofu and then some breadcrumbs (this I'm pretty sure grandma never used though) from PnS. Got home, squeezed some of the water out of them tofu blocks (man paper towels just don't cut it, I want a proper cloth for this!) but not well enough since the result was still pretty moist, and then peanut butter, some pepper, some salt, some dried shrimp, some soy sauce, some salt, some sesame oil, some oats, some breadcrumbs, some ground ginger and garlic.... and some more of that yummy crunchy peanut butter, ball it up, roll it in crumbs again. You would think that it sounds horribly salty. Turns out that more salt was still needed actually. And more peanuts. And despite how horrible and how much I detest coriander.... I think it needed some of that stinky herb grandma loves to chuck in. Gaaaah.... what else is missing? Another thing to squeeze out of my grandma when I get back.

Had a chance at catheterising a guy today. Only problem was I didn't hold it up stiff enough and so it couldn't quite get past the stricture. That and no pee came out, even after the house surgeon stuck it all the way in. :S .... took it out cos she said never leave one in unless one is confident where it is. And haven't put a line in succesfully for ages now. Not that I've gotten much chance at it so far. Gaaaah.... My skills are going to turn munted soon.

What am I thinking now?? I should be studying for the psych interview OSCE thingy tomorrow.... but I'm not in the mood.... sweat....

Lol, this is what one produces with paint when one has too much time on her hands.

Weather today was crazy! Forecast was for the southerlies with heavy showers and snow. Morning came. Hmm.... northwester blowing. Cool but not cold. Fine. Blue sky. Crunchy leaves underfoot. Birds flying past and playing in the trees. Riiight. Stupid weatherman. And boy did he have the last laugh. Afternoon came around and it started pouring heaps. I got out to catch the bus to work and if it wasn't for my precious umbrella I would have ended up looking like I've just been swimming. And I was only walking for less than 5 minutes probably to the bus stop. Ek! And shiver while I waited for the bus to come along. Evening came by, and it snowed. The signboard for the pharmacy got covered in an inch of snow that before closing time I decided to just put it out of its misery by wiping the snow off (and freezing my fingers at the same time) and bringing it in. Just as well Jim gave me a ride home (as usual, I'm such a leeeeeech ^^!) for catching a bus in that weather would have been crazy.

Will have to look through geriatic psych stuff soon in prep for next week. For some reason I can't seem to get interviews successful unless it has been pre-arranged for me to meet them. Psych ward time are good in that I do end up getting info from the patients I'm interviewing. Go on my own to K2 and I get nowhere. Twice now. That certainly can't be by chance. Sigh. Something wrong with me or something wrong with the person on the other end. Next time I'll do what Croucher suggested. Stop it and ask directly. I wonder if psychiatrists are generally cool people. And geriatrictions (who are also pretty slow-ish and laid-back). Because that's what it seems. And if surgeons are kinda the impatient and occasionally ill-mannered ones. But then so far, only surgery and the psych parts are interesting. The problems list of the elderly are just too much for me. Give me surgery where it's wham bam only one problem to tackle and that's it. Ugh. And don't get me started on murmurs. Man I hate lousy hearts. For some reason my ears hear the same thing on everyone, and I only hear the difference after it's been pointed out. Then it's kinda like... yea... I think so.... -_-"'

I feel fat. For some reason this year I've gotten hooked on anything chocolate. I'm still the same weight. It's good I guess, but on the other hand I've been wanting to get back to my previous weight, i.e. before I came here. Damn. Sometimes I really do want to get a knife out and slice off the parts I hate. I've wondered if I punctured myself with a big needle and then stuck a straw in, and sucked really hard, would it work like liposuction??? It makes me wish almost that I've got a job as a model or something to give me the determination to get it down. Lol. Daily 40 hour famines. I'll probably end up binging instead afterwards. Arrrgh. I swear if I ever hit the overweight margin of the BMI scale I'm going to jump off the twin towers, and let that be a lesson to all who let themselves grow fat.

I've handed in my long case for HCE, and still seeing Mr G daily. It's really nice to see that he's improving all the time, though I don't really think he would actually get full function back in his foot and back of the leg, or the fingers. These parts still can't move very well on their own whereas all the other muscle groups can now.

Sometimes I wonder if I would be able to live with myself if I had to lose that much function in my body. A toe maybe. A finger or a leg or a half of my body ..... would I still want to go on? This sounds so bad that it almost seems like I'm passing judgement, and when I'm telling the people I see to hang on they'll get better, but for myself, without my fingers I can't really see myself surviving without them. There really seems no point almost. I like walking. If I ever had to lose a leg, would I still be content to live? At this point it seems not. I used to think that if I had a choice, I rather be hurt really really bad that I wouldn't survive than be be hurt some and have to live with some part of me gone. With dementia I probably wouldn't mind living on unless I know I'm demented, though that's bloody unlikely. But I can't imagine if a loved one became so demented that they couldn't recognise me at all. Would I still be able to bring myself to see them? To love them? I hear of people with their loved ones changing so much, turning aggressive, physically and mentally, with their dementia. A niece refused to continue caring for a aunt after being physically attacked. Would I be the same? On one hand one thinks how terrible of the niece. But on the other, one can only put up with so much hurt before one has to withdraw.
I wish my brain would think less sometimes. -_-"'

Things have been so-so lately. I've sent in a half and roughly done haoura write up. Not much good it seems as yet since P would be away until the next tute, which means I could have just forgotten about it until then and not bothered walking all the way there to get it in. *sweat* Saw Prof S today on the way down from the museum after pathology and good news, so far my draft for the long case looks good. ^^ More good news? I don't need to redo the abdo exam during the next core skills session. Apparently Prof A discussed it with Prof F and they cancelled it, including those who failed. Turns out we unfortunates ran out of time. Lol. Bugger with intro to fake patients I say and those stupid obs from the end of the bed. It's going to be a normal person lying there, why should I bother -_-"'.

Holidays are coming up around the corner. Not really much planned. Apart from doing cooking to fatten up my worm (and maybe do some fishing at the end of the holidays), and stuffing my stinky pet sock in the worm's face to share in the joy of all things smelly, making worm slave away doing my laundry, tidying my room, making my bed, blah blah blah. Lol. And maybe start on the darned ethics essay due in a month or so. Arrgh. I've done one for surg, one for HCE, and now another for the PD thread?! Sigh.

Examining a patient today to do my short case on gave me one example of where it might not be a good idea to resuscitate at all costs. She didn't look too bad at the moment, apart from the fact that she's here for rehab for her fractured neck of femur. But on talking to her, I found out that she's been finding herself more and more fatigued, for a good part of the day now she finds herself so tired she just sleeps. She would sleep about 15 hours a day according to her. Worse in the past few months or so, but creeping on since 15 years ago. Her cardiac output is bad since she gets angina and chest pain. She's sick of it, and says the sooner it comes, the better for her. She certainly isn't depressed at the moment, and she's certainly competent. It's a little sad to hear her say that though listening to her, one has to agree with her almost. And Mr S has been diagnosed as dying. Meds stopped. Comfort cares. Looked really gone yesterday but perked up a little after a good dose of frusemide was given before the decision to withdraw was given. Only thing I can think of is how does it feel to have had a laryngectomy and not be able to talk like others and having to learn of new ways to speak (not that I've ever heard him speak either).

I wonder why I can't even stay awake long enough for a half hour lecture these days when I used to go for a good three hours or more at Colquhoun?? I like to think it's because I'm working hard. But I doubt it. If anything, I'm probably lazier. Or does laziness makes a person sleepier? I'm sleepy. Going to wake up early to catch the social worker to chat to him tomorrow. Time to sleep now.

And home visit was cancelled on me this morning for the second time now. Grrr. Re-scheduled to this coming monday afternoon. Arrrgh. They better not make me re-schedule again. It's hard to make plans that way.

Internet is slowed down again... and will probably be like that for the next few days to weeks? Arrrgh!

Queen's birthday today. Work started from 9am until 3pm. Wasn't too bad today, moderate amount of people coming in through the door, though a good part were scripts. The happiest moment was when I sold a bottle of Audiclean. Yes! Printed out a second receipt and chucked it into the staff incentive bag. Hopefully at the end of the incentive period I'll get an extra dollar for it. Sounds sad. A dollar. Lol. Must try to sell more. Sold one once, but then didn't realise I had to print out the receipt though and now it's too long ago so that's one lost now. All this while on the staff progress sheets I've been making about 300+ in sales. Somehow it's hard to imagine having sold that much, so for the first time I made note of it, and so it was. Got to about 330+ in sales. Can't imagine how that built up. And since the witch-hunt for people not checking their areas of responsibility for outdated goods is still ongoing, I've gone through mine quite thoroughly, and a bit of the other areas as well. Chucked out quite a bit more expired goods. Mostly eye drops, moisturising creams and some facial scrubs. Short dated ones I found were mostly from the 'bowel' area.... mainly metamucil products essentially. Couple of benefiber bottles. Lol.

Still ongoing with the maori project. I've no idea how to classify some of the stuff she's told me. Which question should they go under?? I guess a trip to Mihi would be in place sometime soon to get it straightened out.

Been looking through some cake decorating ideas. The two that I'm itching to try out and play with are plastic chocolate (or is it chocolate plastic? :S) and MM fondant. They look really exciting. And I'm still looking through for cake recipes that I can make into my mainstay recipe. Currently it's the chocolate wacky cake recipe on the back of the chocolate melts bag. Wonder why they call it mud cake though when it clearly is based on a wacky cake recipe. Vinegar and baking soda. *shrug* Found one recipe that I've yet to try and make though. Perhaps this weekend if I'm motivated enough.

Can't wait for Friday. Want to try and make those treasure egg bags thingy. Sounds more elegant than what it actually is. Heh. Eggs. Got 15 sitting in my room and 12 in the fridge. Yes, it's sad. My pantry space is so limited that I'm resorting to using my room as storage.

Happiness is really a very simple thing to achieve I've realised. Opportunities for little rays of happiness to fill us are everywhere but often are not given enough attention. I realised this when I saw this pretty little gingko leaf fluttering to the ground. Such a pleasant shade of yellow, such a graceful shape, it was beautiful. For a moment my worries that afternoon looking for a suitable person to interview melted away and seemed distant and insignificant. I wonder why in the midst of things, little joys that make me happy fall by the side ignored. I looked out the bus and felt warm rays of sun, saw a great big green field, saw a glorious blue sky, fluffy white clouds, the puzzling but cute streak of white falling through the sky, and the autumn look of trees heading into winter and felt content to enjoy the my bus ride while I can. Happiness can be a simple three word phrase, or even single words that all children share.

Yet what puzzles me is thinking back now how when I'm sad nothing will get through the dark cloud that settles around my head, allowing me to do nothing but ruminate my sad lonely thoughts. Funny how Dr C said that those in the medical profession are different when they get depression. They function normally even if they are depressed, they go on and on and on until they crash, and when they do they go utterly out. When I'm sad that's what I do. Immerse in everything around me, work, study and pretend around friends. Nothing shows. Nobody guesses. It's almost like a game of hide and seek where I'll always be the best hider that no one finds. But because I'm the best hider, I can't come out to the seeker because that means I lose.

I was asked if I ever get stressed. Thinking back now, how often do I get stressed. Not very often probably. A lot of my stress comes from my feeling unprepared for exams, hormonal fluctuations that happen to coincide with little incidences that push me off the edge (which normally wouldn't), and most of all the weather, housing... living environment. Living in better conditions now as I approach winter makes me realise how poor living conditions affected me before.

...Olga found him lying on his back looking at the clouds and asked him what he was doing. "I like to think and wonder," Alexei replied. Olga asked him what he liked to think about. "Oh, so many things," the boy responded. "I enjoy the sun and the beauty of summer as long as I can. Who knows whether one of these days I shall not be prevented from doing it?"...

Dropped by the stroke ward again today to visit my long case patient. Wasn't planning to do any examinations today, told him that but he didn't seem to believe it lol. And then he offered to let me do some work on him, saying he didn't mind, so I thought I might as well do a cardio exam on him today. Oh my oh my I sure didn't know what would be coming up then. I knew he had a patent foramen ovale from the echo results he had previously and from what he had told me about his little hole in the heart, but certainly wasn't expecting to hear anything different from normal from that. So everything was normal until it was time to ascultate his mitral area. :S... what on eart is this I hear. Sssssshhhh dup Ssssssshhhhhhh dup. Oooook. Find his radial pulse and tried to time it with the sound. Hmm..... so first heart sound was the one where the murmur is. But I wasn't expecting to hear it and I guess I must have looked worried/ puzzled? Because he then asked me what did I find after I finished. Immediately warning bells rang in my head. But considering I was already ... 'caught out' I thought I might as well tell him what I heard. After hearing what I said he looked a little puzzled... and worried possibly since this was the first time the murmur was mentioned to him apparently so I offered to let him hear with my stethoscope. He couldn't really hear it. So I made him lie back down on the bed, check that I could hear it and gave it to him to hear. At this point I could tell he was a little worried even though he couldn't pick out what I heard so I offered to get the house surgeon on the ward.

Poor WT because he was busy with ward work but then since I'd already made poor Mr G worried he thought he better come and listen now. WT never listened to Mr G's heart before and therefore was quite surprised when he picked it up. Offered to go through his echo results to check what it was. Then came back and slowly explained it over to Mr G. By the time it finished it was quarter past four. I first came to get WT at about 20 to four. :O ..... I felt kinda bad for putting Mr G through the stress and then making WT finish late since his actual finishing time was supposed to be 4pm. Accck. I need to develop my poker face perhaps. Didn't get to stay to talk long to Mr G after that since his wife then came.

Before that though he was telling me how he was feeling a little down that morning. Because the guy in the bed opposite had got to go home for a day and he couldn't. At least the OT has offered to check out his home this Wednesday and assess if that were possible for him. I do hope it works out considering I seem to hear from a couple of patients how bored they were there. Times like these make me want to give the person in front of me a nice big hug and tell them I'm sorry as well but then I doubt that's forgivable as a professional. I just use touches to communicate. I can't say thank you to patients for letting me do unnecessary examinations on them verbally. Partly because it feels false, and saying it loudly doesn't seem right to me either because some of them are pretty hard of hearing. So touching them on their hands lets me tell them what I wish to say.

Strokes are so much more interesting. Probably something I've said before. But sometimes when one sees and thinks about the devastation that it leaves behind I feel kind of sad as well. My bedside tutorial today was about strokes, focussing on non-motor aspects. The first lady we saw made my heart ache. A nice cute grandmotherly looking old lady. All smiley and happy to try and help as much as she could. But she could barely speak for she had non fluent dysphasia. I asked her why she was here, and she could only barely get the word brother out and even then I had to guess it. She couldn't understand very well complicated instructions, such as scratch her head, even with a visual clue. But worse was the fact that her insight was intact as I could see her clearly struggling to get the words out and look plain frustrated when she couldn't understand what the instructions meant. Yet through it all she kept trying to smile. It was heartening to hear at least from Dr H that she had improved quite a bit since when she first came in she could practically make no sound. I wonder how much she understood what was written on the get well cards I saw on her bedside table? I wonder how it feels to have to watch someone you love go through that sort of struggle with something so basic that we all take for granted?

Yet at the same time, not all is sad. Mrs H has her husband who comes in everyday. Mr G's wife visits everyday as well. I feel touched and warm inside when I see Mr H wheel his wife about in her wheelchair and take her out for walks when it's sunny and still. When he watches her learn to walk again and follows her to her physiotherapy sessions and provides moral support and encouragement. I guess with stroke, while it takes, it brings out the love in people as well.

And on Sunday was SS jie jie's 'toilet-warming' party. Rather the toilet was an excuse to meet up with friends and catch up. Dress code was to include something .... toilety? I donned my pyjamas and wrapped a towel around my head and took the bus from home in that. I bet Hui who saw me at the bus station in my jammies must have thought I had lost a couple of screws. The bus driver sure looked at me odd. Hehe. And people slowed down and stared somewhat as I paraded down Ric Rd to the bus stop. Somewhat that was oddly fun. Even if it probably was the wrong sort of attention. Should I blame my parents for not making me the youngest or making too many kids and hence causing my unquenceable desire for attention??? Lol.

“There's a cross on the side of the road
Where a mother lost a son
How could she know that the morning he left
Would be their last time she'd trade with him for a little more time
So she could say she loved him one more time
And hold him tight
But with life we never know” 

“There is a man who waits for the tests
To see if the cancer has spread yet
And now he asks, "So why did I wait to live till it was time to die?"
If I could have the time back how I'd live
Life is such a gift
So how does the story end?
Well this is your story and it all depends
So don't let it become true
Get out and do what we are meant to do”

I visited MR G, my long case study patient for the HCE module today. He was having his acupuncture session as usual. As it was during his OT session yesterday (I asked Mr G how it felt like having the electrodes on that the OT placed on his forearm, he answered it felt like a buzzing, when the OT piped up asking if I wanted to try. I was feeling wary, said so, to which she replied, stick out your hand and something along the lines of let’s have fun torturing the medical student), the acupuncturist offered to let me have a needle in the back of my right hand. I was feeling quite afraid, the needle was quite long though thin. But then Mr G had said earlier when I flinched while watching the acupuncturist put some in him that this might be my one and only chance, so I agreed. I barely felt anything though when it went in I must say. When the acupuncturist tapped the needle in, I expected a jab of pain. But nothing. I felt nothing. It was only when he advanced it further in that I felt a slight sort of odd sensation. Barely feel-able. I wonder if it actually works. Mr G sure is improving quite quickly, but is it due to the acupuncture or to his diligence at his rehab exercises I don’t know. But what I know, is that he doesn’t mind even if it doesn’t actually, just having them gives him hope. What a powerful word that is. Right up there with motivation. I hope he gets better and attends his son’s wedding. I’m trying really hard to convince him to go no matter what still though.

At the end I was telling him I had to go now because I had work in the afternoon. He looked absolutely shocked. He knows what my parents do for a living. He knows and I know that I’m from a relatively well to do family, otherwise I wouldn’t be where I am or going home at the end of the year. He says I should make use of my youth and not waste it. Go have fun was what he said. Don’t wait until I turn out like him. It left me feeling a little ... shaken? It was partially the thought that had been lingering in my mind all this while at the back of my mind. I desire that of course. What young adult doesn’t? Especially when I know what’s coming up for me after I graduate (I was not well informed of the outcomes of my choice almost 4 years ago, otherwise I would be an allied health professional instead). But I desire to have be semi-independent. Or at least create an illusion of such. I want to not be one of those snivelling babies who leech of their parents. I want to have the dignity of an adult. And it’s bad, but I want cash. I can do ok without it anyway, but having a bit more money to put away as savings and enabling me to be a bit of a spendthrift is really tempting. I’m not yet graduated, and I’ve a debt that seems massive to me. I will need a car by next year probably. I want to have my own apartment once I graduate. I’m not money oriented, but as I near graduation, these things become more real to me. But I remember that I haven’t been to walk in the gardens for ages. I haven’t been to see the talking chairs. I haven’t gone to the arts centre in a long time. Am I really wasting my youth?

I want to travel and see the world. I find stroke patients more interesting than fractures. I enjoy the time I’ve spent so far on the stroke ward (I’m such a traitor to my own ward). But deep deep deeeeeeep down a thought is emerging in me. What if I’m one of them. I’ll work till I retire at what? 65? That’s the age of some of those on the wards. Or lately like poor C’s brother. 17 and died from a MVA. How will I achieve my little dreams if I accidentally end up like that? I shall aim therefore, not to wait till I retire to do what I want. I hereby promise myself I will travel little by little in between, even if I have to do it on my own. I shall take the holidays that is due to me in future. Fingers crossed.

I can’t wait for the end of the year. I must pass that stupid Gen Med run. Stupid Dr J with all his perfectionism shan’t kick me down. I must get home this year. I shall give bola the knocks on his head that are due, mumiaks and nana will give me the kisses and hugs that I want, and the worm can return to be my minion in evil and greatness muahahaha.

OSCE went not too badly I think. The physical examinations went quite smoothly, though I've no idea what took me so long that I never finished the focussed abdominal exam. The vascular exam was easier than I thought. I finished quite early for that one, except that when feeling for the femoral pulses my fingers touched something that probably shouldn't have been at that spot at all! :S! The oncocology station wasn't too bad, for some reason I knew all the stuff in my head, but I wasn't very sure which information he expected me to spout. The way some of the questions were phrased were kind of odd, and occasionally I didn't manage to dig it out and phrase my words very well either. Irritating thing was a call came in midway on the examiner's cell and disrupted my line of thought. Even though he told me to just continue I couldn't simply because I doubted that he would be able to hear me talking. The gastro one was alright. I got the right diagnosis, but it was quite uncomfortable interviewing the patient with the examiner scrutinising me as well. The patient wasn't as forthcoming as I hoped but managed to ask quite a few specific things which was good. Emergency medicine was great for the airway management skills part. The scenario in which it came in wasn't as good though. Knowing that some things activated charcoal can't be used for in gastric decontamination isn't enough. Which ones? I only remembered alcohol. This foreign word Golytely came to mind but I doubt it was it and didn't mention it. Prof A then went on to fill it in for me. Metals and something else I can't remember now. Oh yes! How could I not rememeber it?! Gosh, people should stop trying to poison themselves and that would make life easier for everyone. Use some other way please. Sweat.

Today's would be the Pathology OSCE. Brain died yesterday trying to go through the the questions and the pots, which most of them look strangely unfamiliar to me. Worse of all are the histology slides I must say. Pleomorphic, hyperchromatic, granular chromatin.... err.... if you say so. They still look pretty much normal to me unless I have normal ones right next to it for comparison, which doesn't always happen. After spending most of the day trying to answer the questions without peeping at the answers we had wrote down previously we gave up for the last two tutes. And it is interesting how it's the same questions, same tutors, and yet sometimes we had totally different answers written down on our sheets. Which one is the correct one??

Lately it came on the news that the ECP would become government funded, meaning women who want it no longer have to pay for it. Despite what I hear about it being able to promote promiscuity amongst the young, I doubt it. Simply because those who are already doing it will continue to do it. Those who are not, won't simply because it's not what they are in the first place. After all, it's not as though free condoms aren't available. They could have done it anytime they want anyway without having to wait for the ECP to become free, especially when it can be obtained for free before this from health clinics. And it's not naughty kids who need it. I've seen married women come into the pharmacy asking for it. At 40 bucks a pop, not everyone can afford it, some are actually turned off by the price. I see this as a way to protect women as well. Regardless of wether the act was right or not, denying women access to the pill and making them have unwanted pregnancies would only endanger them. One, there are always cheap dangerous ways to abort a pregnancy (last year we were made to watch this horrid video about illegal abortion, and one of the women actually stuck knitting needles into herself) which would probably kill the woman. Two, having a child and being a single mother when one isn't all that willing probably would have serious effects on the mother's wellbeing and perhaps even worse for the child as well.


And today is the second day of the second strike by junior doctors nationwide. I'm not sure if in the end they'll get the pay rise they so rightly deserve but I admire their effort. Even though I do sympathise with all those whose elective surgeries may be cancelled, I do think that a pay of low 20+ per hour is not reasonable. Considering they've spent 6 years studying accumulating a debt of humongous proportion, and having to work like a dog simply because that how it works here, a pay rise doesn't seem to much to ask for. I doubt if what they are asking for is all that much, considering what the board spends on locums already anyway who earn more than double per hour of a permanent doctor. And even my good old hs has gone on strike. He was overworked the last time the others went on strike, covering his own team and another, because he had not joined the union yet and therefore had no reason to strike, but was still paid the same. That's sad.

What's it with my brain as well that it doesn't seem to come up with good comebacks until it's too late anyway? OR why haven't I been taught to be more rude and thick-skinned? Seriously, the fugly nurse just enjoys picking on students. A pox on her I say. Grrr...

Thinking back to what we learnt during Ethics, our duty is to our patient and therefore despite popular belief, we can over-ride family requests for the benefit of our patient if we do not think the family requests are in the patient's best interest. It sounds nice and simple, but I doubt it's easy to do due to an interplay of various factors at times.

Patient A and B are both Mr U's patients.

Patient A is an old woman, 90+ y.o. She presented with bowel obstruction. Is still clear in her mind and can speak well. She was an ex-nurse. She refused invasive procedures and had discussed this with her daughters. When Mr U did his ward round, he was talking mainly to her daughter at which point Patient A requested him to speak to her instead to her daughter regarding her treatment. She told him what she wanted and that she had discussed this with her daughters already. Mr U agreed and that her management would be a matter of watch and wait and give gastrogaffin and let nature run it's course and keep her comfortable meanwhile. After leaving the room, Mr U agreed that it was probably the best choice, rather than go in with surgery and then die in pain. As an onlooker I feel that Patient A is getting what is in her best interest, i.e. treatment as she wishes and maybe dying the way she would like.

Patient B is a woman of 80+ years who speaks only Mandarin and no English. She's presenting with vomiting two weeks after her partial gastrectomy for stomach cancer. Her son and daughter insists that she be treated with more surgery asap, or the daughter would take her mum back to China for treatment as soon as her mum is able to be moved. Mr U speaks no Mandarin and relies on the interpreter to communicate. He talks to the son and daughter as the mum shows no interest in proceedings. They talk above the bed, without involving the mum. The children do not explain to the mum what is to happen either, and treatment for her does not involve discussion withe mum. Once, on leaving the room, I saw Patient B shaking her head, unnoticed by anyone else, not Mr U, not her children. I doubt the children knows what Patient B actually wants with regards to her management. So does Mr U. Personally I'm under the impression she does not actually want all these treatment anymore. She had to be persuaded by fellow colleague who acted as interpretor once to accept the nasogastric tube and I was told it was reluctant acceptance on Patient B's part. Is it right to conceede to the children's requests? Is it worth taking time out to ask what Patient B actually is thinking, even if it means getting the kids out of the room? What if she wants no treatment? Is it alright to say no, my patient does not wish for further treatment and in light of her advanced gastric cancer and age, I shall not follow the requests put forwards by the children?

Talking it over with a friend, the friend came up jokingly with the conclusion that Asians are greedy for life (we all were Asians btw). I laughed and said nothing. I doubt if that is the case. I'm pretty sure that Patient B herself is ready to accept palliative care, but wether or not that is true no one will ever know because her children are not ready to accept it that their mum wouldn't last very long with invasive treatment and probably doesn't have very long to live anymore, with or without treatment and do not talk it over with her. No one will ever know because the mum doesn't attempt to put forward her views either. I think the baseline is that denial and ignorance will rob poor Patient B of a good end, unless, and I can't imagine this, the idea of a good end is to do everything even if it means pain right to the end.

Anyway, surgical OSCE this Tuesday, Path OSCE this Thurs. Whew! Study revise study revise! Aja!!!!

I've got a faint idea so far what's the upcoming surgical OSCE is going to be about. I'm kinda confident about the abodminal and vascular examination parts, not so much the rest. Not so much for the Path test as well coming up two days after it. Acck. Hopefully they'll put out more information soon.

Was asked to put in a line into Mr K today by my hs but after looking up and down his left forearm and seeing two little puncture holes, and feeling here and there, and not finding any real veins that I can confidently (or even semi-confidently) access, I gave up and gave the task back to the hs. He felt here and there and then kinda felt one and jabbed it in and got it. Sigh. I'll give myself a fair chance next time, more credit and so on, and shall jab it even if I'm not terribly confident. I need and want practice desperately. I really really want to do a sigmoidoscopy too!!!

Borrowed Kumar and Clark today from the library and took ages to lug that darn heavy bulky thing home. Along with my music folder which makes things even harder. As I checked it out, I thought to myself would my parcel arrive today? And when I got back, right in front of my room door, was my parcel. Yay!! Goodies. And dang, why did I get that book out now that I've my own??!! Lol!

Did my last ED shift on Monday. Had this really nice icelandic registrar supervising. Lol. What supervising. I'm more like haunting that anything. Interviewed a lady who came in with an allergic reaction. No idea what it is though. Nothing that jumped out in the history at all. Also saw this lady of 65 who was attempting suicide by slicing her wrist horizontally. She obviously bled lots. Her hair was matted with her blood and so was the bed she was on. She was given 3 units of blood and lots of saline just to keep her going. The plastics surgeon came in and his registrar took off the bandages on her wrist. I must say she did a really really good job. It looked practically minced, mutilated, red, bloody all over, and I SWEAR something bone-looking could be seen from where I was, on the opposite side of the bed where the cut wrist was. Mr Plastics said can you move your fingers. Pathetic little wriggle on her index and middle fingers. Last two stayed flexed. And to my horror I saw a little small lump of ... unidentifiable tissue.... gave the tiny-est of wriggle on the cut surface of her wrist. Eeeaccck.... As soon as my own registrar walked out I quickly followed. The post-mortem session was bloody, but what does it matter when the body is already dead and unfeeling and cold? This is bloody, but she was alive, and I can't imagine how determined someone can be to be able to slice repeatedly to deliver that much damage to her wrist. Deep down I've admiration for her resolution, though I wish her resolution had been channelled into something else. That or cut it properly so that she wouldn't have to survive with a hand that would be practically half-useless from now on. Funniest thing was my registrar had to go into the room later again to consent her for the bloods that she already had. Do you agree to have the bloods that we transfused you with madame? No I don't. Get it out of me. I wonder what's the point even.

The old Chinese lady with the gastric cancer that I saw in Mr Utley's OP is back in again. I saw her in ED on Monday as well as I was about to start my shift. She's been put under the surgical team on call. I wonder if I should visit her?

So Mano-mano called up about her pay, and will tramp down (ahem, using bus no. 8x, not 11 of course hehe) to her workplace come Wednesday. Thank goodness for private health institutions is all that I can say that I have free time on Wednesdays. :P And hopefully get it all sorted out on that day. I honestly cannot remember at all when I actually started work. But according to T's diary, it's 8/3/08. So it shall be.

I've made dinner. I fried up some noodles with the Chinese sausage mum sent over. I wonder if it's my technique, or maybe it's just that I've never really gotten used to electric stoves, or maybe I'm just frying too much at once, but the noodles look a lot like something that might have popped out from the pseudowok of some bastardised American Chinese takeaway. Ugh. I feel somewhat disgusted looking at it and feeling sorry for my cooking skills. But at least it tastes good. Yes, I ran the taste test. Hot food freshly cooked is just too good to pass. Actually I think I know what's wrong. I overcooked my veges. My beans look limp and sad. Though I noticed that it seems to do that with just a little heat very quickly.

Looking through some onco stuff. Looking at the survival rates made me think of the guy I met during my session at the onco clinic who just found out then he had HCC with maybe slightly less than 2 years left to live, even though he had been tested couple of times here and there to check for it. Apparently the gastro guy never told him. It shocked him. It wasn't very obvious because on the surface he appeared very calm. But inside, partly hurt and emotional pain? He had a 15 year old son still and a wife. But maybe relief as well? Since he said he had guess something was up when they ran all sorts of tests on him. And he had been doing some research on the internet as well. And then I think of Mrs N who ovarian cancer mets. Cancer has never been so real to me until this year. And while I know people can survive and bounce back to where they were before. Just that it's scary and while listening to the oncologist explain things to the guy, I felt a twinge of sadness deep down inside. But then again, I walk out of the room and I forget. The little twinge gets pushed far away into the darkest corners of my cupboard up there and lie almost forgotten. I find myself wondering what do they actually feel knowing their diagnosis and prognosis? I feel like asking but never seem to have a chance to. And then again, knowing the prognosis, while it may be bad with very little time left, is it necessarily a bad thing? At least one can be half sure about something. At least one can make preparations to one's best, and therefore be able to die happy?

Taken at St Clair during our pilgrimage to Dunedin. Had to redo the shot goodness knows how many times just to get it right :O! Can you spot the two sexy tummy flashers? *giggle* I daren't considering how well fed I was down there. Omani fed us all sorts of yummy food cooked specially for us, and best of all was her kimchi which restaurant ones never seem to match up to. *sniffle*

Back up in Chch again. Met up with a few friends while down in Dunedin. And Chyi is coming back up to Chch and meeting her on Sunday. Along with RJ and XL who are coming along with her. While Chch is in some ways better than Dunedin (better housing for one, though more expensive doh!), I find myself wishing that I could have transplanted all my friends up here. Clinical years can be difficult to make really close friends unlike our two bookwormy years before, since everyone's doing their own 'thang'. Not that it really matters much in the end when I really think of it, since there's internet and what not now, and our schedule doesn't really allow as much free time as before. And all I want to do after coming back from the hospital is just go online, eat and laze. And maybe my cross-stitch while it's going.

And here's icky video my worm made me watch:

http://www.youtube.com/watch?v=vpv9P1KOVMQ

Highlights of this week:

Putting a line in an old woman during my acute day and actually getting it right the first time round and causing her minimal pain.

Using the vacutainer method to draw blood twice without missing (though the second time I had some problems keeping my hand steady and some air leaked into the vial).

Using the butterfly to draw blood twice as well. I must say even though the vial filling rate is rather constipated with this method, I really love this one better than the vacutainer because the needle is just smaller, hence my being more confident of not missing and making the process less painful.

Receiving a bright beautiful sunflower. It's the sun in my room at the moment.

Being hugged and being told that I'm dear to someone.

Meeting up with Jie jie for lunch today and seeing her after so long. She promised to take me on an hour and a half walk to the sign of the takahe, wherever that is actually. And to show me her
new toilet and bathroom when it's finished renovating.

If I avoid the topic, nothing gets solved. If I try to address it, my concerns are waved off. Had I been unlucky enough to not be able to express myself that the problem was a needs issue, would it have been just written off as a problem of perspective? It would seem as though my thoughts and feelings mean naught in practice. What one says and one actually does are in conflict.

I'm doing my oncology question and powerpoint presentation because I'm happy to do it for my group. Not because I'm obliged to do so for I could have easily signed it off to someone else, or just as easily given my path tute on Thurs and my acute day on Thurs itself as an excuse to not do it. There's a not-so-subtle difference there. Is it not obvious?

My ceroc dance is so far limited to three steps. I'm told that I should be happy with that, and that after time, once the three steps fall into routine I wouldn't be unhappy with only three steps. It's all a matter of perspective after all. I've always detested having to compare myself with others, I rather compare internally with what I have and what I want and strive to acheive the latter. But when one system gives up, the others are inclined to follow and break down. So I'm supposed to be happy with three steps because if I learn too many I wouldn't appreciate the beauty in them anymore, and I'm better off than those who don't know any at all after all.

Jack of all trades, master of none. If I have to simply be a jack who knows only three steps, then I'm probably no better than those who know none. Could I possibly be worse off? For then I know that I'm lacking and am distressed by it, wanting to be better. If I knew none to start with and hadn't a need to increase it anymore, then I wouldn't be distressed at all. Is it not better that way then?

A pet may grow or not, but if it's needs are not met, would it die? If the owner isn't worried it would die, but the pet is, is there a problem there or not? Is this a case where it's like Spongebob, when he forgets about Gary and Gary then leaves, and Spongebob then realises that he misses Gary. Why does it sound familiar? Because it's happened before but in a different setting. But then it seems the owner is happy to let the pet have needs go unmet over and over again.

The pet spends most of it's time with that of it's own, and rarely sees the owner. The owner said it is inevitable when the pet growled that it was practically weaning off the owner. The owner said that his own kind have needs too and that he had been neglecting his fellow humans. The pet understands the need, but why does the word inevitable gets used only with the pet? The pet questions the reason behind the owner's words for it feels that it does not get much more time with the owner than other humans. The owner gets upset when the pet plays with others of its kind when the pet ends up seeing more of its own kind, but yet the pet is told to be content with what it's getting even if it's not getting enough to meet its needs.

Off to read some more oncology for Friday. Acute day tomorrow! Hurrah!

House looks like a hobo in this one... :S

This is the last week of the Surg/Gastro run. Next week I'll be on Surg/ Onco. Both are parts of the surgery run though, just that the other half of the run changes midway. Which meant that both the groups on the surgery run didn't have to go through the OSCEs this week. Whereas the Cardioresp physicians and GPs that I know were all too happy to practise percussing out my lungs and moving my limb joints.

The cat has finally been let out the bag as well. The Ethics lecturer told the whole class as well that we'll be having a practical skills week in place of the Integrative week. Yay! Right now I just want to get heaps of chances to stick cannulas into people, simply because I still suck at it. Why on earth is it not the practice to anaesthetise people before doing it here, whereas it seems as though that's the case up in Wellie?? It would certainly make life a lot less stressful for me and the poor fella on the receiving end of my needle.

Starting class on Tues. Not that I feel like it. Easter holidays need to be longer :P!

ED shift was comparatively uneventful today, unlike my other shifts. Funny how there were two overdoses today. One with BDZ, alcohol and marijuana and who surprisingly wasn't dying from respiratory depression. He actually walked all the way to the hospital through the gardens, could talk pretty well too. Complete opposite of what I had imagined he would have been like. C/o a sucky life (wants to see PES but was denied by the service itself lol) and feeling tingly and weird all over (surprise surprise....). Had pretty bad folliculitis as well and kept asking for blood tests done for them (he said he bathed everyday... but I could smell him though). The other was a lady who came in comatose who had overdosed on fluoxetine, paracetamol and alcohol. Or so it was suspected. Not sure how those three can actually konk someone out that badly though, cos' she wasn't responding to any stimuli except pain. She had to be intubated. When the specialist turned to me and said you can do the cricoid, I actually panicked for a moment thinking that he had mistaken me for a TI (or someone higher up the food chain) for I thought I was supposed to cut something. Lol. Turned out I had to just push it down on that point so that I closed off her oesophagus while my supervising doctor intubated her.

R was put down for an ED shift tonight as well (I made him do it so that he can walk me home after). But seeing how slow it was he decided not to do it tonight. But he came back in the end to get me as well. For that I'm really grateful. Maybe after my acute weekend I'll make something for him (if I don't die from exhaustion as M said of Shaman!). ^^!

Mumiaks and Nana, and my two loyal devotees, worm and ball, I might be at the hospital until late tomorrow, but I've no idea what time I'm finishing. So I might or might not come online. Will post here to update though. Muaksies. I love you four.

www.chetart.com/confused.html


Our ward rounds have gotten very short now. There isn't any on W16 (and that's supposed to be our 'home' ward too :S!) but since that was where our team usually met before starting, TI, M and I were all waiting there this morning waiting and waiting and waiting for the others to turn up. It was purely by chance we looked into the next ward down the corridor and spotted the reg that we realised that they had practically done the round already. *sweat* (and surprisingly my reg actually understands what I mean when I draw the big sweat drop by my side of the head in response to something he said. Think it was something to do with his over-obsession with Arsenal and football). Only patient left that hadn't been seen was Dr M's new patient who had Cushing's syndrome. It was a good chance to observe some of the features of Cushings, though not all. There was the mood changes, easy bruising, truncal obesity, peripheral wasting, buffalo hump, lethargy and so on. She didn't get any striae or moon-face features though. She actually didn't really look what you would expect a Cushing's patient to look like, considering all the pictures we get bombarded with in second and third year. I found it quite easy to explain the disease more or less to the patient as well which made me feel kinda happy. Using simple normal everyday terms too. ^^ Didn't get to watch the operation which was scheduled that afternoon though because Dr W went on to have his outpatients clinic (with a broken arm and torn tendon? :S!!!!).

He came for the student teaching this morning as well and went through some little bits about history taking, though focussed mostly on RUQ pain. I quite like the way he teaches, and I do appreciate him coming in despite his injuries. And as said earlier, he attended the afternoon clinic as well. Good for the patients of course. I'm not blind to the good of being a workaholic of course. A good role model for a student of course as suggested by someone. Though I do wonder how much does it get before one qualifies as a workaholic? For one I remember wanting my own nanny to be home when office hours are supposed to be finished. I remember resenting patients calling up home as well because I don't want to share my parents after hours. Thinking about it now, is there anyone as selfish as me out there? Personally, while I find acute days to be a good learning experience, I don't really like staying at the hospital doing 'work/ study' for so long. It's almost like when it comes to acute days I don't have a life of my own. A one off weekday is fine of course. But I'm half dreading the weekend acute a little. And I can't make myself not go to any of the days because I'm only having a little over two weeks now on this run (as well as having to find to subjects for my two reports eeeps!!!!). Isssh.

I got rejected today as well. By a patient. I was hoping to take a history and maybe do a breast examination, but barely had I stepped in through the door, the nurse told me that the patient had specifically requested that there be no students attending to her. Sweat. Back out the door and off goes reg to do it instead. Not exactly happy but whatever. I guess this being the first time this has happened it took me completely by surprise.

Nurse Maude wound care clinic tomorrow morning at 8. Will have to wake up super early and bus there. Hopefully it won't be as ... funky ... as TI puts it lol.

My team's new house surgeon was supposed to come in today. But didn't. Because she wasn't MRSA cleared yet. Poor A continues playing TI cum HS. The poor thing can barely keep up with the stuff she has to do. And I've no idea how to write out follow-up notes yet, and can't keep up with what the consultants or regs are saying and hence can't help her. And my team is ever growing smaller. Poor Mr W (who types a lot like Nanny, just one finger less, hehe... no offence of course, cos he types awfully well for single-finger typing... just a little too slow for my comfort... had this urge to ask if he'd mind I help out. An offer which of course never made it out of my mouth. I like brushes with danger, but on this occasion, cowardice won out.) fell off his moutain bike while adjusting his sunglasses going around a wet corner, broke his right clavicle and pulled (or did he actually break it??) a tendon in his left wrist. He came in to see Miss M while I was at her OP and my jaw nearly fell off. So he'll be out of action for some time now. I'm pretty sorry, cos he's overall pretty nice and a good teacher... and dare I risk it, quite good looking. Lol. Not that I'm after the old man. Somehow he reminds me lots of nanny :S (though like Misch puts it, seems to have a volatile quality about him, which hasn't had evidence to show for it yet though. Maybe how he looks stern at times??), just maybe not as long winded when explaining stuff, and nanny probably has a longer and flame-resistant fuse. Ok, maybe not very much like nanny. Just the typing bit. *Why do I sense my neck, or rather my ears are in so much trouble come Fri night??* None can match up to the volcano yet though, even though the volcano seem to be less active these days. Heh heh.

And I saw in OP today this little old lady I liked a lot as well. I don't know what was it about her though. Actually, in general, I quite like little old white haired ladies that are pleasing to the eye and well-natured, soft-spoken, and yet have this sprightlyness still. As in a lot. It makes me wanna hug them, but I don't, of course. But anyway, she came in for follow-up and had to have her seroma drained cos there was some fluid collection there again. She had the warmest hands ever. But it hurts watching her having needles put into her to have the drainage done cos I can tell when it goes in she felt quite uncomfortable. Maybe because I've seen her hurt more before, but somehow I felt wanting to be her knight in shining armour, but yet not knowing how. Good thing she's all better and getting discharged and I won't be seeing her again, hopefully. Goodness, reading this over, it looks like I'm rambling.

Tutes today were dead boring. Unfunnily boring. Boring that I didn't what to do to help myself stay awake properly. It all started with the lecture actually. EBM tute was a total disaster. I feel really bad for the guy that he'll have to think about how to change the teaching content to suit the surg run, considering that it means that all his previous efforts are wasted. Looking at his face, which somehow on the surface was devoid of emotion, yet looking rather strained, when Misch and I explained how we felt, made me feel really sorry that things went this way. I missed my gastro tute as well today because I was too engrossed in my OP and forgot about it entirely. I'll have to chase up my patients soon and then crash Friday's tute and report to Dr B who runs that tute.

Pharmacy training today as well. I met Nick. Who was a cytologist (stopped it in the end because it was making his eyes go nuts) and now studying to be a vet nurse. Likes animals heaps as well like a certain worm out there. But that's not my point. I really admire somehow people who have the courage to pursue their changing ambitions. And have the courage to start from the bottom later in life. And have the strength and tenacity to see them through it. I have strength and tenacity to force myself through medicine of course. Though I doubt if I really ever had the burning fiery passion in me for it in the first place. And I often wonder if I'm alone in this. I'm in medicine simply because of chance and of the friends I fell in with while in y13. Not that I really had the passion for a law cum sci double degree either. But I don't have any real passion in life now I feel. I'm continuing medicine because I feel that I can't turn back. I've put so much effort that I'm afraid I might not cope with myself should part of me ever choose to turn away from it. I like meeting patients of course, but not in the setting where I feel stressed as well, simply from wanting to get the info I need (but then I suck at history taking still as well). I want to enjoy their 'company' (?) as well. Does anyone understand that sentiment or am I the only one I wonder? But no, I'm a coward because I know should I ever develop a passion for something totally unrelated and which cannot include medicine, I know I can never be able to pursue it because part of me will never allow it. I'm passionless at the moment I feel, which when I think about it, is rather depressing as well. I'm excited at the things I'm learning, because they're novel, but once it's gone, then what? I'm probably wondering unnecessarily perhaps? Part of me aspires to be better, to be a passion driven person who'll be happy doing some job she loves dearly. Hopefully that passion can be cultivated. Hopefully it'll be something I see next year or later this year.

And I should sleep now because I wanna do ward rounds tomorrow. Might pop into ED and do a shift in the afternoon if Mr W isn't able to have OP :(

Yesterday was the first acute day the surgical team I'm with had since I've started the run. Started at 8am and ended probably close to 11pm the same day. Most of the time was spent in the ED though, in the workup area, where the patients that would end up being under our care would be sent to from the main receiving area (complicated~).

It was pretty confusing at first, since we had no idea what to do. The Jr Reg didn't show up at the ward where he told us to meet up. I ended up floating around a little and finally made my way to the OT where he was doing a laparoscopic appendisectomy (a mouthful, and took me some time to think out the spelling lol). After that then toddled after him into ED where after some time he realised that I needed something to occupy myself with, told me to go take a history off one of the patients.

I can't say I take very good histories. Despite having been told the order and what to cover, I still end up skipping stuff. Simply because... because I get stuck somehow in between. I'm resisting the temptation to take out pens and paper and slowly write and question as I go along. It would certainly help with recall, for I know that when trying to report back I have to stop and think for a loong loooong time for things to come back to me and having notes to prompt me would be immensely helpful (not to make sure that I don't look like an annoying and idiotic fourth year). But writing certainly slows me down a lot, and I don't want to seem like I'm not interested in what the patient has to say by writing while he/she's talking. And I can't write and listen at the same time. And I want to practice my recall skills. What should I do I wonder? So terribly annoying.

More annoying is when a group mate who knows that the patient is assigned to you tries to take the history himself. Good thing M is there to back me up, but considering there's another 8 weeks to go in this run as a group, I might as well let it go I guess. *rolls eyes* Another thing though, with this incident, is that I seem to be rather blur perhaps? I have no idea what's exactly so very funny with my remarks sometimes. But they do make M and the jr reg laugh sometimes. I didn't realise I asked myself questions out loud. I thought I was asking the jr reg. No?? I need to make recordings of myself one day. Lol. But just as well, rather than the whole bunch of us being in ED being solemn scary zombies. And seeing others laugh makes me wanna laugh, which makes us all happy. But yes, zombies. Maybe not the others, but towards the night, after dinner time, I was starting to feel rather zoned out. I just wanted to get back, have this whole acute thing over and sleep.

Another interesting thing during the acute night as well was that I was given the perfect chance to put an IV line in. Yipee! The hs asked if I would want a 'babysitter' and I said no. Right. I so regretted it later. The guy was a pretty fit and in his prime. Rugby player sort of built. Hairy as well. And had pain due to what I later found out was a pilonidal abscess (even after doing a wiki search, I'm still not very satisfied about it. Somehow it makes no sense to me). So with my whole vampy paraphernalia by my side, I made the first poke. I used a green cannular. Curses to the lady who advised me to use that. IT was SERIOUSLY BIG and before I started I whispered to M that it didn't look good. Seriously, it's size freaked me out a little. Ok, maybe not that big, but I was pretty sure my ex-TI had used a smaller one. But it was really hard to insert and even after I thought I was pretty sure I was in, there wasn't any blood. The patient was hurting I could tell from the way his hand trembled a little. Pulled it all out and blood started oozing out. Press it down and on goes the sticky. Embaressed. And feeling dreadfully guilty. Try another time on the back of the hand. Went in. Blood filled the tip a little, so lower it and push further and the filling stopped. Pull needle out. Nothing. Shit. What now? Pull out cannula a bit hoping to pop it back into the vein but obviously the poor guy, had he been really nasty, could just have whacked me on the head. It probably would have made me feel better as well. Get it all out, sticky on, PAGE! PAGE! PAGE THE HS! And the patient was saved from me. Despite the pain I caused him, atop whatever pain he already was suffering from, he was still it's alright don't sweat it to me. And I saw the hs use the smallest, the pink cannular. 22? No idea. But I think it's 2 sizes down. The heck. That woman. Because of her I could have well ended up killing a patient by hurting him to death. T_T I'm still not sure if I want to go back and check up on him considering all that's happened. Not sure if he would want to see me....

But for the first time, the morning ward round took ages to complete. Two hours maybe? Not sure. But long enough. X-ray meeting. Student teaching. Apparently Mr W is one of the few surgeons who actually don't mind teaching us. Though this second session was mostly on what next if the patient gets diagnosed with breast cancer. Then lunch. The endoscopy at the Gastro department. Saw a PEG put in, apparently it's like a feeding tube, straight into the stomach. Gastroscopy. Colonoscopy. (I'll never be one, I can't imagine doing many colonoscopy... don't mind watching, but I don't want to do it myself heh heh). And whatever the last one was called, flexi? It's just the last one I watched, because the last patient on the list could possibly be having some transmittable disease and Dr B practically chased me away. Out of concern of course, though I would have liked watching it. I'm now tasked to follow up two of them and report back to him. Dr B's nice, despite being a bit loud and rather blunt. And loud is good I guess. I wonder if my hearing is going off a little, because I don't seem to hear as well as I think I should. But yes, blunt indeed. I need to talk louder. He made me tell one of the patients that there was nothing abnormal seen during the procedure. The poor guy was old and probably hard of hearing. And I had difficulty raising my voice enough to get it acceptably loud. And one cute little old lady was found to have rather diffuse gastric cancer. At the end of it all, Dr B told me she probably had three months left. Why? How do you tell? Because of her age and her anaemia and how it was diffuse and how she was vomitting blood occasionally. I guess it's reality, but somehow it hurt a little hearing that. I could get over it of course, since I'm not attached to her, but even then, she seemed a nice thing, and she didn't even know about the cancer and 3 months left thing, and ... it's just wrong? At least she didn't seem to be in pain. But this brought the question I had in my mind for a long time back to attention. How on earth does cancer kill someone? Unless it affects something major, the stomach thing could be side-stepped by all sorts of ways though. And how does one determine the max tumour load a person can take? Why 1 kg?

I noticed as well. During the PEG, even though it wasn't anything really horrible, it was a tad disturbing that the procedure which involved puncturing the stomach, the patient wasn't actually konked out the whole while. Just slightly ... sedated? And it takes a bit of getting used to with being able to see his face. Compare it to patients in OT. All I see is a boob, or small bit of stomach. And I know the patient is well under anaesthesia. It does make things a lot less uncomfortable, knowing that they won't feel a thing until later when the anaesthesia and pain killers wear off a little. But to tell the truth, it's quite intersting and fun to watch. Like... discovery channel almost. Almost. Just no animals.

End of week 1 since uni started (for my class anyway). This first week of my Surg/Gastro run has been really tiring. Partly because not having a proper master timetable stresses me out greatly, and partly because trying to figure out my way around CH takes a lot of brainpower. It's comforting to know though that my senior reg is lousy at finding his way around as well and had to get the other members of the team to draw floor plans for him at first. Lol.

I haven't done any outpatient clinics with my consultants yet, or any endoscopy list. But I have been to a few surgeries that they've done. Mostly mastectomies, an incisional hernia repair, and one haemorrhoid removal. Surgery seems fun, since one gets to use their hands a lot and figure out how to get from point A to point B without accidently slicing through something that one shouldn't. I can't actually say for sure though, except that it looks fun from an observer's point of view, since the furthest I can get in terms of participation in the surgery is to hold the scissors to snip suture threads, or hold the retractors, or pull on some part of the anatomy using skin hooks or my hands (and maybe burn a few arteries so far upon request). I doubt I'll be getting a chance anytime to do anything but those sort of things though, not even the end bit of suturing up things, since we were all told that we were not to touch any of the sharps even if requested. Though then again I'm pretty sure the convenor doesn't have eyes everywhere... :P The bit I don't like though is the smell of the smoke that gets released when the diathermy is used to slice the flesh. Burnt meat in the pot can sometimes smell (and even taste) appetising, but this smell is something else totally. I wonder if that was the smell that the audience at the electrocution gone wrong in the Green Mile experienced, since the diathermy runs on electricity as well. I find that I actually love scrubbing up and getting to wear the apron and gloves and mask and all too. Though I should start thinking about moisturising my hands a bit more often heh heh. But I do wonder though, do the surgeons get bored after some time since the anatomy is practically the same for a big part of the population? I certainly wouldn't want to perform mastectomies only.

I've felt for the first time as well how advanced breast cancer can feel and look like. After the patient agreed, I ran my hand along the upper bit and bottom part of her breast as my consultant did. The bottom part where the cancer was and had infiltrated the skin felt... knobbly and warty and ... wrong? Compared to one where it was a small lump in a breast that had been taken out from another patient. I had so much difficulty feeling for it when asked to by the consultant. And when I did it felt no more different from any normal breast lump that comes and go that I have as well :S!

I need to learn to be stronger as well. It really hurts me inside as well when I see patients in pain. When that little old lady who my sen. reg was draining the blood from her wound (she had a mastectomy which then went on to bleed longer than expected even after the drains were taken out) cried out in pain, somehow my heart cramped up too. It didn't help that she was a nice little frail looking old lady who was saying that if she had known that this was coming she would never had mentioned the lump in her breast to her GP :(

Friday morning was the mortality and morbidity meeting (M & M, yum!). One surgeon talked about a patient that came in that week. 8 year old boy, in car accident, restrained using lap belt. Died. Apparently the injuries he sustained were almost like he had been cut in half. Ouch. And not a one off too. A couple more surgeons piped up about similar ones they had seen. Another said that studies showed that lap belts were not much help in accidents and were actually dangerous, and when he asked some car company representative why they continued making cars with lap belts, the answer he got was because it's legal -_-"' Right. And so people can continue getting cut in half then. One surgeon then asked if it might be better to not wear anything then. Which no one dared to agree to.

Fast forward to Saturday morning. I had my ED shift. Midway in the shift, call comes in from ambulance. Car accident. Two back passengers injured. 6 and 8 year old females. Both unrestrained. 6 year old was thrown out back window on impact, and was thrown 10m away (don't know about the 8 year old though, there somehow wasn't documentation about how she ended up outside the car either). My first thought = oh shit, they're going to die, they're going to die! But guess what, they didn't die. As a matter of fact, they were pretty ok. Besides being rather shocked and upset and crying from fear and pain, they were ok. No broken bones. 6 year old had cuts on her legs and parts where skin was just scrapped off. 8 year old had a laceration on her forehead which took 4 or 5 stitches, a big boo boo on the side of her right thigh where the skin came off, and lots of grazes on the knees and sides of her calves and toes. That was it. I was pretty upset and angry that the drivers (not the parents apparently) could let kids go unrestrained. But thinking back to friday's meeting, perhaps it was a good thing then?

Moral of story? Never go unrestrained in a car and never wear a lap belt. I wouldn't suggest going unrestrained rather than wear a lap belt of course, but then I think I would rather risk dying than risk losing half of my body and my mobility with it.