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.

From now on I promise that I will never again not remember to bring my camera whenever I go out somewhere that I know might carry the possibility of having flowers around. I've missed quite a few chances while on the marae visit to Akar, and a few as well just before the trip when I was buzzing around the gardens.

So it's Sunday now. Sis left early this morning with her beloved and one of my in-law. Hoo hoo, and these words are coming as a reminder for mum and dad to cut their losses early and also because now that sis's well away in Palmy, and me safe and sound down South here, I can bleat as much rubbish as I like without fear of repercussion. Double hoo hoos. Despite my hoo hoo-ing, it's really hateful though to have to be left behind without family again. Watching Aunty S iron B's shirts and pants yesterday before helping him with the packing really made me jealous. Groar! How dare he or anyone be pampered when Mano-mano hasn't her mum to pamper her?! Huh? Huh?!

Dinner is cooking downstairs right now. I'm still not really into the mood for cooking. After cooking for two over summer, having to think about feeding myself only now seems kind of a pointless exercise. Especially when I'm the sort to get highs on bread and peanut butter and yes, raisins! (Peanut butter has got to be the magical go-with-anything for food. I heard from a friend that a friend of hers takes roast chicken with peanut butter and jam! MmmmMmmm, but I've got no roast here... ) But at least I've managed to kick myself into making the laziest yet most comforting dinner of all. Soup. Lol. Back to standard cook for the weeks' meals routine again. Minimal prep and watching required. Grin.

My first run will officially start tomorrow... with... not a bang, but a lecture, a ward round, and a whole big big BIG bunch of tutes running until ... wth.. 6pm?! Sigh. Cry. Groan. Nice way to start off the run and year. Not really looking forward to it, and yet kinda looking forward to it as well. Can it get any more contradictory? Don't think so.

And played Balderdash yesterday as well. I'm surprised with the type of stuff that our minds can make up when pushed too. Wonder what the colour the brains of my friends and sis are? Though I don't think anyone can come up with stuff other than what they did for the movie title 'Rentadick'. And boobook apparently is some little Oz owl that knows only two words - 'More pork'. It's a scary pest I tell ya. Go into the pig pen at night and you'll see it digging out some poor piggy's throat. Lol. I wonder if the creative part of my brain expanded a teeny weeny bit? Should I be happy for that little expansion, or should I be more worried about what functions I might have lost instead because of that expansion? oi h aoiwhr vntio toh .... oh daer, lsot teh spellig prat of my bairn. Booooobooooooooooooooooooooooooooooook!!!

Today was a pretty interesting day. I'm really lucky to have been attaced to the nurses at the cardiology day ward for the shift with a nurse day. Rather than actually shadowing just one nurse (or the nurse that the list that we were given had put me down for), I was shadowing practically the nurses working in the cath labs overall.

I had no idea that minor surgeries would be done that closely to a ward. Dunno why but somehow I thought that hospitals were separated into surgery, ward, outpatient and emergency. Each in one building. Though now that I put it out in front of me, I realised that I would have laughed out loud if anyone said that to me. *shrug* Pa-bo.

But I observed stuff that not many others of my class would have had a chance to see. I had fun helping out the nurses with some little chores. I saw angiograms being done. Some going onto angioplasty. I saw one pacemaker being put in (after the first few incisions and as the surgeon was digging in trying to open a space in the pectoral area, I stopped and realised I was hyperventilating - wonder how many people do that?? :S And it was hard trying to slow my breathing down simply because it was really gross seeing him pushing and tearing at live flesh like that... though I managed to think less of it afterwards.. until sewing up time lol). Before I left I saw an 'acute' come in. Most people came in for angiograms though. 95% of what I saw were angiograms probably. Not that it made much improvement in my skills at looking at the angiograms. How the surgeons and nurses accomplish the spot the lesion game so quickly is simply beyond me. I actually need someone to point it out to me. Unless it was seriously bad to the point it was almost occluded. Lame-o. Sad.

I'm pretty surprised at how quickly and efficiently the nurses work as well. And how diverse their roles are. And they work really well together too. They seem more like a little community themselves almost. It's how they rotate their shifts and do their handover and what not. Not to mention that they were more open and ready to help and teach than others in the surgery. They were very keen to explain things and it's surprising to me how much they know about pharmacology and anatomy and what not. It seemed pretty detailed. My knowledge about the arteries there start at L and R coronary arteries and end at LAD. Intricate details ... diagonal this artery and that... huh?

I got to wear scrubs too. Haha. Somehow it made me feel less an outsider with them on. Not to mention this odd sense of joy... like I was promoted somehow from being a lowly student to something of worth. Lol. And while in there I had to wear lead jackets and a thyroid collar as well. As one of the surgeons put it, for the sake of my future generation. *raised eyebrows* Perhaps I should have said I didn't want any and therefore cared not an iota for them and stood nearer to the xray machine, I would gotten an even better view of everything? :P The sterilisation would be the bonus kekekekeke. But they seriously weren't fun to wear for long. A while maybe. But with the jacket weighing at 6-8kg, my feet got pretty sore after some time. Not to mention my shoulders too. I'm amazed at the nurses and surgeons who have to wear them everyday. The short breaks in between the surgeries where everyone quickly took off the jackets were not really much of a help. To me at least.

Time to sleep. Hopefully the day with a doctor would prove just as interesting.

Halfway into the first week of orientation now. Halfway simply because it's a holiday tomorrow and so there's only four class days this week ^^ yay!

It's pretty hard trying to get up early in the morning though since I'm still a good 20+ mins bus ride away from hospital. Thank goodness it's still light though at 7 in the morning and so I can actually still get up when the alarm goes. Thank goodness the bus runs that early (they start at 6.15 am actually, bless those hardworking bus drivers .. xx0xx to them!) otherwise I can't imagine what sort of walk it would be to get to class. Lol. 15 to 20 mins to Cd, and 20 mins from end of Ric Rd to hospital.... and 20 mins from end of Ric Rd to Wstfld.... and no idea how long from Wstfld to Cd... @_@ aaacksss!

Yesterday was pretty much standard admin stuff that we had to do. Do the MRSA swab (my hands were happily occupied up the nostrils and down the groins - yeah, didn't know that word come in the plural form, and arse... naughty slap slap... yeah, they operate indepedently :S), get file photo taken (gosh, had to get it done 3 times!! 3 times because the first my glasses were crooked and got in the way of the eyes, second because I blinked!), get security photo taken (the photo will be taken in 8 secs says the lady, so I smile.... and smile... and smile... and just when the smiling muscles get cramped click goes the webcam and so I'm stuck with a uncomfortable wry evil up-to-no-good sort of smile T_T), and log into student webmail to see if our accounts are working. Got overfed by the uni ppl as well. Not much else registers except for a lesson in history taking and a trip to see a patient to practise that.

And that was when I met a woman of strength. She looked really ill, felt crap (anyone would I think when the pain is 10/10) and still felt the pain even on a cocktail of painkillers, had daily needle pricks for blood tests (sometimes up to two a day), and knowing that nothing much can be done to the problem because it's too dangerous to disrupt the organ. And having a bleed and a clot just before she was scheduled to be discharged which then meant a longer stay and not knowing when she can be out again. How does she cope I asked. Well, there's nothing you can do about it, so you just cope it with was the simple reply. Even when the ppl in the same ward as her are coming in and out. Even when she's in pain. Even when she's got to take this horrid looking concoction for her protein levels. Even when she has not much appetite for food. I was suprised at how simple her answer was, and how she could still laugh and joke even at her own situation, and how she lifted up her hand to shake ours and talk to us despite being really sleepy and tired as well. I felt kind of bad just being healthy when someone can be so ill somehow. I felt kind of bad that I had to see someone ill to realise how undeservingly healthy I am. I feel humbled and wish her all the best. Hopefully she'll get the early discharge as she's so hoping for.

Today was a lot less exciting though. Had a CVS small group tute and learnt a bit about pulses and sounds and what not. Except the registrar went on for longer than he intended to and we had less time with the patient. Still no idea how to find that elusive popliteal pulse though. Didn't get to try it on the patient and I hadn't been able to find it on myself, not since first hearing about their existence. I've kinda felt a pulse there before, not with those 10 sausages of mine, but rather with my opposite knee when I cross my legs for a length of time when sitting down in a chair. Hm... not that it's much help. 'Can you cross your legs please?' Patient crosses leg. 'Now tell me if you feel a pulse'. Yeah. Impressive. Patient then proceeds to chuck quack out of the office in the interest of public safety. Oh yeah.

Rest of the day was pretty much boring stuff. Lecture from library, lecture on infection control (essentially a message to wash your hands properly, you dirty lump'o'poo... yeah, I mean you. Never again shake hands with that guy who's just been out of the toilet and who wears a wristwatch and a long sleeved shirt, unless you wanna his gook that might be hiding near his wrist... ewww...), lecture on pass/fail on attachments and so on and so forth. Including one from the MPS who sponsored our lunch today. Dang, sushi. And aacck, that green diarrhoea-poo-shaped blobby things people even give a name to (seriously, shit like that shouldn't get names, much less be on food!). But they gave us brunch bars and cheezels and burger rings and what not of snacks and juice that make up for anything! Wish they had muffins that we had yesterday though (when I find out who made them, I'm taking them home)...

And here's a ghostie I picked up from an online game (((((((m(0.0)m ... too bad I haven't seen Mano's mangy minion though lol.