moving on!

goodbye and hello!

moved over to www.ditzydoctor.blogspot.com :)

see you there!

not studying

i have an ACLS test tomorrow and i'm not studying, instead i'm surfing blogs. oops!!!

on the bright side, today was my first day shadowing! delivery suite is interesting.
my intern is a generally nice guy, not particularly warm or welcoming but i'll take a person like him over others i could mention any day!
he taught me a fair bit of stuff, reassured me that i wouldn't need much OB/GYN knowledge to survive this posting (hahahahaha), told me which attendings to call and which to avoid, and how to listen to the nurses (esp the senior midwives!).

i got to see an episiotomy (OMG, i think i need to start wearing my specs, i couldn't see a thing amidst all the blood and i was terrified of getting blood into my eyes. specs from now on!) and well, i hope i learn pretty quick so i can do a neat one instead of a messy one - v impt for women!!!

there's a lot to learn, but basically we're glorified clerks and must learn all the paperwork and form-filling.
other advice was to read up on medicine and surgery during this time so as not to forget! v impt, i say! :D

short work days, 5 day work weeks :) i'm happy!

i start with day surgery - meaning i admit all patients for elective surgery, more glorified form filling and blood drawing. hmmmm. but work should be pretty easy, i just need to get my forms straight.

and my first call is on a public holiday :\ rather depressed but hopefully i'll have a day off in lieu of this :D

i feel rather bad for the residents, because of our "newness" and lack of everything, they're forced to do step down calls to fill our shoes and to help us out, esp in the delivery suite! :\ seniors, your help is really really deeply appreciated.

on your marks!

uhhhh i feel so unprepared! :(

in theory i should know how to manage a pre-eclampsia, and GDM patients, how to safely deliver a normal baby, how to manage PPH and do an episiotomy. at the very least!

but the truth is, i DON"T KNOW A THING in clinical!!!!!

OH MY GOODNESS.

first day of job shadowing starts tomorrow, here's hoping i learn something and don't die in the process!

new new!

frontier psychiatrist is a "newcomer" to the blog scene (meaning i haven't read his blog before this).

his site is pretty interesting - read the parts on "things that have given psychiatry a bad name"!

the part that freaked me out the most was the one on lobotomy:
(http://frontierpsychiatrist.co.uk/things-that-have-given-psychiatry-a-bad-name-1-lobotomy/) <--- i need help on how to hide this link please please?
and it's accompanying article. so brutal!

anyhow just helping to drum up support, and no, i'm not getting paid. hahaha!

internship coming up

posting results are out today! i have gotten one of the postings of my choice, and i'm right pleased with it :)

OB/GYN, coming right up my way! :) 4 months of women and babies, i think i'm going to love it to bits.

the people posted there with me are mostly nice, all aquaintences (but then again, given my reputation for being gossip girl, i think there's hardly anyone in medical school whom i don't at least say hi to), well, minus ONE person who has an incredibly bad rep.

let's call this ONE person Prawn. he's arrogant, pushes people around, and doesn't ask for things nicely. he takes on responsibility and runs from it at the last minute. he has grandiose ideas and comes across as really impressive but in reality, he can't carry them out.
but he also has some good points, like being generous, i have to admit.

we'll see how it goes, hopefully he'll have turned over a new leaf!
but i'm not going to let that spoil my enthusiasm for OB/GYN. it's time to dig out the books for some refresher courses on how to read a CTG and what to do if there's primary PPH etc.

EXCITING! :)

ps. i'll be moving over to ditzydoctor.blogspot.com soon :)

i passed! :)

title says it all - i'm super relieved and happy given that an unexpectedly large amount of my classmates failed this round. shockingly large amount, in fact, and amongst them many whom we thought were far from failing!

i guess i'm a doctor now, and i'm torn between being extremely happy and being terrified of having patients lives in my hands. but it's what i've always wanted, so here's to more medical education! :)

just back from grad trip, had a blast! :) hope you all are well!

surgery clinicals

surgery clinicals today, hopefully i'm a clear pass!
couldn't have asked for nicer examiners (well, except one).

tired, more to come but thanks a million for all the good wishes!!!! :D

final clinicals on sat and sun. 4 more days!

week 2

week 2 is down, we've trolled our way through another 3 horrifying papers plus a communications skills OSCE of 10 stations worth.

medicine essays were alright for me, but mcqs were again another horror. this time, i fell asleep despite during the paper despite drinking coffee in the middle of it and 3 toilet breaks to wash my face :\
plus i'm pretty sure i got a lot of questions wrong so that was even more :(
eg: young girl who is febrile, signs of SLE, renal punch +. what is your first step in mx?
others: RESUS
me: give iv ABx. :( OMG! :(

but at least i made one lucky guess - entacapone turns your urine ORANGE :D
go me, i am the queen of ridiculous answers.

modified essays were a HORROR. it's an evolving scenario but you just can't be sure of what they're asking for.
plus the questions were really really BAD.
eg: using a bone marrow aspirate to diagnose TB
eg: managing a patient with status epilepticus complicated by anaphylactic shock to phenytoin
eg: reaching a diagnosis of an elderly man who has just travelled overseas to a rural place infamous for having CSWs (commercial sex workers) with his family, and is now feeling malaise and has a fever, and you get ONE investigation. lovely.

and you know the best thing? our "lovely" prof even commented on someone's facebook note: i think all the papers to date have been fair.
FAIR???? far from fair if you ask me. give ANY ONE, including profs some of the questions we had and see how they do before you tell me it's fair.

osces was like a game, i zoomed in and out of stations and talked alot of rubbish, thankfully mock patients were nice. my hands shook so badly when i was suturing that the examiner laughed at me!
and i've never removed staples before so my prof even showed me how to do it in the middle of the station whilst saying:"girlie, it's obvious you've never done this before yah."
to which my meek reply was: " err, not really prof". duh.
at least osces was alot better!

clinicals are coming up - rumours abound about weird cases aplenty eg. von Hippel Lindau syndrome, charcot marie tooth (HSMN1), osteogenesis imperfecta etc.
i have no clue what to expect, but hopefully i'll recover from this beating by the medicine theory papers to face the clinicals with my head held high!

mbbs, 1

day 3 of exams has ended, and i'm exhausted. i've averaged 4 hours of sleep a night (my usual is 7! AHHHHH). my skin is sallow and my eye bags are HUGE. a friend who doesn't study with me had a big shock on seeing me today in the exam hall and said i looked terrible.
i then got a further shock on looking at myself in the mirror. OH MY GOODNESS :(

the things stress does to you - i forgot to eat breakfast before my exam today! :\ thankfully i was saved from hypoglycaemia by the sweets i sneaked into my pencilcase throughout the 3 hours. gracious.

exams so far have only been surgical theory papers, but oh my goodness they seem to be going from bad to worse.
doing 180 multiple choice questions with tricky tricky wordings and double negatives made my head spin. people tossed coins, fell asleep during the paper, and headed for plentiful toilet breaks. MY GOODNESS.

and me? i had diarrhoea through all my papers. WHY IS THIS HAPPENING TO ME????
thank goodness i sit in front of the toilet in the exam hall!!!!

2 more weeks!

minutes to midnight

2 days to doomsday!

sorry for lack of updates, been sitting in school attempting to squash stuff into puny little brain (seems to have gotten smaller, much).

lots of discussion going around school - realised that if i had gone to states instead i would have had an easier time facing boards rather than being at the mercy of examiner's questions and unfair distribution of cases etc etc but that is another story for another time. first to pass my MBBS and then i'll talk about USMLE and heading to states to train!

2 days to go, 2 days to go. brain is shrinking by the day, tiredness is increasing exponentially. many of us are all bemoaning this, and wondering how we will ever pass with our current little knowledge (of course, typical med school "snipers" kick in - lots of moaning and groaning and wailing about being stupid and daft, and then owning all our arses with their immense knowledge and making the rest of us feel like dirt - i have plenty of friends like that. HMPH).

but i am also going to miss this last round of studying together, we will never do such things again and have such great company! :(

the long unrelenting AHHHHHHHHHHHH

there is that long, unrelenting "AHHHHHHHHHHHHHHHHH" in the background noise of my head every minute of every day, a clue to the underlying stress.

final year is really a cycle of ups and downs - stresses and boredom. you keep looking at the same material, thinking you know it already, only to be shocked into stress when some doctor pops you a question on basic stuff on to find you've already forgotten it/ don't know it quite as well as you thought/ totally clueless.
(FYI, i am usually in the last catergory :( how daft)

my stress levels have been rapid cycling several times in a day, up down up down up down up down. something to that extent, maybe more!
it's enough to drive a person mad. plus i get resting tachycardias and sometimes i wake up at night with palpitations and drenched in cold sweat from an exam nightmare. AWFUL :(
worst of all is not being able to sleep because of the stress induced palpitations! :(
i should really start taking a beta blocker soon or i'm going to fall to pieces before the exams even start.

i'm manifesting my stress externally by having pain in every single place you can think of. my orthopod tutor was laughing at me for having more pain than an old granny.
i have chronic back pain, knee pain (from chondromalacia), shoulder pain (from impingement), thumb pain (from cheerleading, zookeeper's thumb), a mucinous cyst on my finger and toes, hyperlaxity causing flat feet and lax ankles.
and oh, neck pain from not sleeping well and headache from all the pain :\
no wonder he was lauging at me as he went through my list one by one! but he was very nice about it and offered to prescribe me beta blockers if i needed them. i think i'll take him up on his offer soon!

the long unrelenting AHHHHHHHHHHHHH? i have to learn to deal with it (no, i am not hearing voices yet. just one voice!) and hopefully it will spur me to actually studying instead of sitting in front of my books and mountains of papers pretending to study so my parents won't nag at me. :\

2 good things about this week:
1) ortho is FULL OF EYE CANDY :D my favourite tutor has a lovely sexy baritone and is really hot, to boot. he radiates charisma and i've obviously been swooning over him and my friends are so exasperated with me they roll their eyes at me every time he walks by. haha.
2) i saw cute medic boy (now a doctor!) and he remembers me! :D oh, joy!

happy valentines, you all! :D

countdown: 2 weeks

infectious diseases is over, and i have failed the test miserably. i'm a little shocked and dismayed (alright, make that quite, it's been quite some time since i was failing mathematics regularly). but i suppose i deserve it, having not studied as hard as i should have!

anyway. there is this new thing on facebook, a meme called "25 random things" (which reminds me, i haven't done dragonfly's old toy meme yet! oops i'm so sorry!).
and to my ultimate shock and horror, i realised that so very many of my classmates have put down: i don't know what i'm doing in medical school/i think medical school is the wrong choice for me/i shouldn't have chosen medical school etc.

it breaks my heart to read that. i know of so many others who would have given an arm and a leg to get in but couldn't because these people have taken up their places (not undeservingly though).

coupled with the facts that:
1) medicine is no longer thought of as a "noble" profession - litigation rates are up, patients are becoming more and more non-compliant
2) complaints against medical personnel are on the rise
3) burnout rates among doctors are higher
4) slipshod work is also higher

stuff like that gets you down.
i was really depressed for quite a bit to learn that so many people thought that way.

i was one of those people who decided that i wanted to be a doctor when i was young (i really enjoyed bandaging my sister and jabbing her to make her feel "better", all in the name of play, of course!), and i firmly made my choice when i was 14. nothing has changed my mind since then (except for a short period of time when i really felt that i should have done nursing instead, but i'm over that now. more on that some other time).

but such is medicine, such is the job and the demands on you.
i never expected to make such a huge lifestyle change, to have almost no "university life" to speak of, to be totally out of the loop with the rest of my friends in other faculties, to wake up early early early and go home late late late. so many things, so many things.

but it has never changed my desire to be a doctor, as much sadness and ugliness and frustration i have experienced (there has been a good deal more than most people, i am sure! largely due in part to my hearing problem and others). i still hold onto my idealism, and i can only hope it won't fade that much 20, 40 years down the road.

i still want to hold a granny's hand and tell her it'll be alright, we are here to take care of her; to tell a pregnant lady to keep pushing, her beautiful baby is coming out soon; to play with a kiddo and watch his smile (which will make my day); to tell jokes to an elderly gent and see his eye crinkle. people make my life, and my life is medicine. there isn't any other way.

guitar hero

i received a bit of a shock over the week, not sure whether the news is good or bad but i'm choosing to look on the bright side for now! :)

lately my group of friends and i (and almost everyone i know) seems to be addicted to wii's guitar heroes! :) most fabulous. except that being ditzy (by name and nature) me, i am constantly making a fool of myself on the songs :\ doesn't help that i'm tone deaf as well!
but it's great fun to sit around and watch as people get disinhibited and start yowling and wailing over songs such as livin' on prayer (my favourite!), complete with hitting the high notes ;)

i introduced my parents to wii - and my mother promptly whupped my dad in wii tennis almost effortlessly! that left my dad grumbling lots (i guess men's egos are big huh) and being rather unhappy - until he thrashed my mum at wii golf. hahahaha. boys will be boys i suppose.

on the medical side, we've started infectious diseases and it's only the 2nd posting that i really quite dislike :(
i don't quite mind the HIV patients, the STDs etc. it's really the whole infection control thing that gets me - it's so super inconvenient and scary - i detest the thought of carrying MRSA or VRE. as a result, i'm obsessive-compulsive about washing my hands and cleaning my stethoscope between patients and it's so time consuming cos i really really wash them :\

ID physicians are incredibly and their knowledge of lab results - after all, their diagnoses depend almost solely on lab results sometimes!
but i have to admit i was stunned when an attending lecturing us managed to give percentages of symptoms of how patients might present.
for example: nausea is present in 50%, and vomiting and diarrhoea in 30%.
he went on to do this for each and every symptom!!!!
granted, it's only rough percentages, but me, i have problem remembering all the symptoms, let alone the percentages!!! gracious.

today, attending (same as above) asked me, " so what are the causes of malignancy responsible for pyrexia of unknown origin that are not blood cancers?"
all i could stupidly say was, "ummm, solid organ tumours?"
i think he wasn't happy with my dumbness and gave me a scathing look. oops.
and sadly, there is no happy ending to this story - i didn't get a chance to redeem myself. it feels like geriatrics all over again (except there was a happy ending in that one!) :(

3 weeks left in clinicals, 2 weeks of study break and the BIG ONE arriveth :(
just as well i guess, rather than being in a state of eternal limbo!

weeeeee areeeee the CHAMPIONS :D

so we won the softball tourney! :) despite me playing terribly and my old injury flaring up and having to sit out most of the last few games, (all the medics on the team have diagnosed me as having supraspinatus impingement, probably with rotator cuff strain and early osteoarthritis - ahhh, the perks of having eager medics as friends), WE ARE THE CHAMPIONS!

only now do i know what certain death means, we really came back from the dead!
each of our final 3 games was won in the bottom 5th innning (we play a modified version of 5 innings) when we were up to bat, and won each game by ONE measly run. that's really cutting it close!
but we won! and i've never been so elated in my life. my team spent a good few minutes just hugging each other and screaming our heads off, showering kisses all round. heh.


alright on to medicine stuff:
the new internship employment packets have been given out, and we've been asked to list our matches and selections for the upcoming intern year. problem is, they've changed the system completely from our seniors time, due to a new employer (some shuffling around, i'm clueless), so that means most of us a clutching wildly in the dark at our decisions, except for the very brilliant and brainy top few who are assured of getting what they want.

for me, it's a gamble. should i go with medicine, surgery and OB/GYN or should it be medicine, ortho, OB/GYN?
what if i don't get OB/GYN??? (besides throwing a fit and sinking into depression and crying all day, i mean) what would be a better choice? medicine, surgery, ortho?

coupled with all my friends choosing different things and all of us being on different areas of the results spectrum, (i believe i'm somewhere in the bottom half, sadly), it's a whole new confusing world.

clearly, i'm going to have to put in some hard thinking on this one. and i need to get myself a decent passport photo when i'm not half asleep or with hair that sticks out all over :\

ahhh, the perils of growing up! :(

anyway!
it's the first day of lunar new year so HAPPY NEW YEAR (again) one and all! :)

blisters, warts and all

i have multiple blisters on my hands right now from softball trainings, as well as corns/callosities and warts (for which i blame the boys, i have not had warts since before this year, before this team!).

the whiner in me wants to shove my hands into the face of everyone whom i meet and gain some sympathy (pathetic of me). and the masochist in me somehow tells me to appreciate the blisters, warts and all, because i'll never get them again. not from softball anyway.

i know it's my final and last last last season, but something tells me i'll have a hard time giving it up.

come sunday night, it's time to hang up my boots, keep my glove and bat and helmet.

wish me luck for sunday's matches! :)

bring in 2009!

so we've reached 2009 (and i have shamefully fallen far far short of my 2008 resolutions!)

HAPPY BELATED NEW YEAR EVERYONE! :D

this year, my resolutions are simpler (and in no order of importnance):
1) to keep off coffee (i'm pretty sure i will go right back on it once i'm post-call)
2) to pass my finals (either 1st or 2nd try, hopefully not longer! :\)
3) to work out/exercise more (my increasing weight is reason for worry. uh oh) - should i go with a gym membership or gymnastics classes?
4) to spend more time with my loved ones (super impt)
5) to spend less in light of the economic crisis - really time to rein in my spendthrift ways!
6) to get on the right path to learning to be a good doctor - in terms of attitude, teamwork, compassion, conscientiousness etc, not just in pure knowledge.
7) to devote more time to church, i have been MIA muchly this year
8) to organise my room (uhhh, this is hard. i am probably one of the messiest people on this planet)
9) not to complain and whine so much!
10) to blog more regularly and not be so boring (heh)


much love to all of you! :)

the one about shoulders

is shoulder crepitus normal? because i don't think so :( and i have really bad shoulder crepitus in my right arm and none in my left :(

i think i'm a prime candidate for osteoarthritis of my shoulder! :( this is worrying. maybe i should give up softball, it's straining my shoulder far too much anyway. but after this season!

or maybe it's the hypermobility (i can bend my little fingers backwards to touch the dorsum of my hands!) that's causing the crepitus?

uhhhh. this is freaky.

(this all came about in playing the game rayman's rabid rabbids on wii!!! and guitar hero. i do declare i must be the shittiest player on wii alive, i have no sense of rhythm and i keep fingering all the wrong notes and pressing the wrong things. ARGHHHHHHH)

merry christmas one and all! :)

here's hoping you all have lots of love laughter and fun this season! :D

test!

i had my end-of-medicine-posting-test on monday this week, which was rather nothing short of traumatic.

first of, i had a funky hot russian lady as my tester (who looks fabulous and oozes fabulousness out of every pore! even her clogs were so funky i wanted to faint at her feet), but sadly, i had a hard time understanding her accent. uh oh :(

next thing - she's a gastro attending, so i thought gastro would be alright, given that it's my pet topic! sadly, it wasn't to be :(

my patient was a previous healthy young gentleman, who's a permanent resident in my country, working for the railway system.
he presents with:
1. fever of 1 week, 40 deg. worse at night and spiking
2. diarrhoea of 1 week, 5 times a day, watery and of normal colour
3. vomiting of 5 days, non-bilious non-bloody. unable to keep food down. up to 11 times a day
4. jaundice of unknown length, recognised by his wife on the 3rd day of fever "eyes turning yellow"

past history of pulmonary TB, treated for 6 months and deemed cleared. nil other history of note. no previous surgeries or blood transfusions.

family history of diabetes mellitus (type 2) and hypertension on his mother's side. father has a prosthetic valve inserted (unknown reason). uncle had liver cancer.

not currently on any meds, no recent illness, no known drug allergies.

has been residing in my country for past 4 years, wife and child came over 2 months ago.
not stressed about work in any form over last 2 months.
previous sexual history except for ex-wife (now divorced), and she is well.
no contact or travel history, colleagues are all fine.
no recent ingestion of seafood.

so there i was, heading happily to a diagnosis of hepatitis A (most common and transmitted faecal-orally), with differentials of cholangitis and other forms of hepatitis.

and stupid me, only notices the PICC line in the last minute, and upon asking about it - it is revealed he had a liver abscess, went for I&D and is now on iv antibiotics.

ARGHHHHHHHH!!!!!!!!!!!!!!!!
and all this was revealed in the last minute of my test - my whole test is now changed from a diagnostic problem to a management one. and i know shat about liver abscesses because they're usually managed surgically where i come from (and surgery is my next posting so obviously i haven't read up on liver abscesses AT ALL).

and of course, i got royally screwed over by my funky fabulous examiner, who must have thought i was an idiot for not knowing a thing, plus my friend (who took the test with me), managed to get an easy case of painless jaundice (diagnostic problem - the actual answer was a cholangiocarcinoma! goodness). :(
strike one :(

strike 2 came when my friend had a 6th nerve palsy with some conductive hearing loss in a young lady, and she was unable to even come up with a proper list of differentials for the causes of an abducens palsy. i was biting my tongue so hard i thought it would bleed, and i felt like the small kid in class who desperately wants to answer questions! :(

and my case? an elderly man with:
1. diffuse large B cell gastric lymphoma (cachexic looking)
2. pulmonary fibrosis (but not cushingoid in appearance thanks to his cancer)
3. infective exacerbation of his pulm fibrosis (there's consolidation, coarse crackles)
4. bilateral pleural effusions
5. a secondary spontaneous pneumothorax (so it's now a hydropneumothorax on one side)
6. a chest tube with fluid inside

so my diagnosis was:
pulmonary fibrosis with superimpose infection, and bilateral pleural effusions.

she was so pissed/miffed/angry/etc that i missed the pneumothorax, and she said she'd initially rejected this case for exam because she thought it was too easy with the chest tube.
i don't think she for one moment remembered that chest tubes drain BOTH effusions and pneumothoraces, and if she'd bothered looking at the chest drain - she'd have noticed BOTH air and fluid inside.
instead, all i got was her ranting about how pneumothoraces are a medical emergency etc etc etc and how i could have missed that is beyond her and i would make a totally unsafe intern. :(

then she marched me over to the x-rays to have a look, and when i pointed out that it wasn't a tension pneumothorax (no tracheal deviation, no mediastinal shift, no diaphragm depression), she got all huffy and pissed off with me even more and said all pneumothoraces were medical emergencies regardless of whether they were tension or not. (is she right?)
so, strike 2 :(

my second short case was a man with cervical myelopathy, presenting with frequent falls.
he had spastic weakness of both lower limbs, hyper-reflexia and ?upgoing plantars (couldn't tell because he was really ticklish and kept withdrawing).
upper limbs - slight hypertonia, brisk triceps, normal supinator and biceps reflexes.
so i thus presented him as having cervical myelopathy at the level of C7 due to normal biceps reflex and exaggerated triceps.
she wasn't happy about my ?plantars, saying that it was obviously upgoing (but the guy kept retracting his foot! so how can you really be sure?), and she said that the upper limb reflexes were brisk as well, and that i didn't do it correctly. oh well. but i did manage to answer all her questions on cord compression etc (all thanks to ortho!!!! :) so it wasn't a complete waste of time! after all!) and spinal shock and bulbocavernosus reflex. YAY! :)
she did concede that my neuro is far better than my respi exam. :\ but at least i gave her a decent impression. whew :)
(so, NO strike 3!)

my friend's last case was a dead easy bronchiectasis, coarse crackles heard all over the lungs, marked clubbing, chesty cough and purulent sputum.

after the test was over, she did admit that i'd gotten much harder cases than she did. but i cant' help feeling it wasn't so fair :(

oh well i hope the real exams won't be this hard! :(

my 100th post!!! :)

time flies and it's my 100th post! :)
and sadly, it isn't anything deeply meaningful etc, instead, it's my usual whines and moans. uhhhh sorry.

i managed to kill some fat juicy caterpillars in my hostel room! they exploded with green blood. disgusting.
my room is now a lizard haunt, a caterpillar nest and an attracter of all sorts of insects. freaky.
I WANT TO MOVE OUT!!!!!

i donated a pint of blood 2 days after my run, and promptly developed symptomatic anaemia for 3 days- giddiness, tachycardia, palpitations, presyncope, exertional dyspnoea etc. NO MORE DONATING BLOOD TILL I"M FITTER!
thankfully i'm better now :D

clinical test will be next week - i'm keeping my fingers crossed that i get awfully fierce and killer examiners so i won't be so scared in the finals! rather odd maybe, but better to get slaughtered now than in the finals right? :)

must really stop making up signs in my head, i keep seeing raised jugular venous pressures when there are none, hearing murmurs when there are none, feeling hepatosplenomegaly when there is none! UH OH.
missing signs is even worse. i have missed EVERYTHING in any system you care to name. UHHHHH.

doesn't look too good now! :(
and it's only 89 days. ARGH i need a white knight in shining armour please! :(