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Author
The author is a paranoid, deranged and cynical misanthrope who records snippets of her life so that she will remember them when she grows old and withered. The identities of any names or initials on this blog are based on the assumptions of the reader unless otherwise specified, and the author claims no responsibility for them.
Reality
The author somehow got into medical school. Yes, you of the general public, shudder and fear the wrath of an inept doctor.
Loves
Reading, Maisy (my dog), tea, writing (albeit badly), piano, music, junk food.
Hates
Almost everything else besides the things mentioned above.
Friends
Bao Cheng' Bernice' Chien Young' Chun Hing' Claire' Faustina' Felicia' Ferly' Gloria' Irene' Irene & Jiaying' Jac' Jiamin' Jiasin' Jiaying' Lutheng' Karene' Marissa' Melesa' Mingyi' My fictionpress' Pamelia' Pei Rong' Qiu Ting' Rachel' Satires Site' Stasia' Sylvia' The Clique' Vinette' Wenjia' Xin Rong' Xue Ying' Yanne & I' Yanne & Jamie' Zeena' 203'
Archives
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12/01/2013 - 01/01/2014
02/01/2014 - 03/01/2014
03/01/2014 - 04/01/2014
05/01/2014 - 06/01/2014
Chat area
On a more cheerful note (which I decided to stick into a new post in an attempt to dissociate from the stuff in the previous post), we had steamboat tonight since it was the 15th day of the lunar new year! I've always loved steamboat :).
My dad's workplace also organised lion dance and live firecrackers (the really loud ones that are banned in Sg) since his boss is Malaysian. 'Twas pretty awesome indeed! First time in my life seeing firecrackers.
And I stuffed myself so full at dinner that I've been unable to move from my computer chair since. Talk about unhealthy indeed. Also had about 3-4 standard drinks equivalent as my dad decided to open some XO. I nearly chocked on my first mouthful given how strong it is, and slowly sipped my way through it to avoid wasting it. My dad interpreted my empty glass to mean I wanted more, and so I ended up with 1.5 glasses. Blergh. So sleepy since then.
12:24 AM
It's nearly the end of my gen med term, and as much as I've liked it, I'm quite glad that it's drawing to a close. I've learnt heaps from this rotation knowledge-wise. However, I've also learnt more important skills, such as critical thinking even in the face of decisions made by consultants way more senior than me.
But doing so has just made me way more cynical; there've been times when I've quizzed about management decisions for patients (mainly antibiotic use) and been told it's because of the dodgy doctors around, and that I (mere medical student) was right. It's made me feel utterly helpless and plain frustrated. As a medical student, just about no one listens to you except for academic consultants who are paid to sit and listen to you blab/are just really interested in teaching. Often, I'm not even 100% sure about what I'm talking about.
But I think I've developed slightly more confidence in my skills after this rotation. I am actually right sometimes! I guess that's the only silver lining in the dark stormy stratosphere. I get paid shitall, spend just about my entire life doing stuff and studying. And shitty doctors who made those decisions get paid shitloads while not really knowing what they're doing either.
Before people start saying I'm being incredibly arrogant, let me back this up with a case (that has been expounded on by an irate renowned cardiologist and infectious diseases consultant). A 69yo male presented a couple of weeks ago with enterococcus prosthetic valve endocarditis which was only picked up on a regular ECHO by said cardiologist. He'd been having fevers, chills and rigors since Nov, and presented to hospital a week before Christmas with a SPLENIC INFARCT. Infective endocarditis did not cross the minds of any of the doctors treating him despite his history of a prosthetic valve (risk factor) and clear evidence of an ongoing infection. No one did a simple blood culture to pick it up. His splenic infarct was conservatively managed and put down to low INR.
And yes, he then presented a month later as his wife had dragged him to his regular cardiologist review and said that he'd been walking into things especially on the right side, and having ongoing chills/rigors/fever (since NOV). The infectious diseases consultant reckons this poor man suffered microinfarcts in the brain due to the endocarditis, which is causing him to walk into things and also to have a slight facial droop.
Honestly, poor medical care could have KILLED this guy. It's easy for me to say in retrospect that I would have done this and that and known about that, but I think I would have at least had the sense to do a blood culture on an obviously septic patient. With a prosthetic valve.
Similarly, RL and I saw a patient who came in with 3 episodes of collapse without loss of consciousness over 2 days on a background of recent travel to SG, ongoing resp infection and immunosuppression due to severe RA. ED sent him up with a diagnosis of collapse secondary to sepsis from the resp infection. When RL and I took the history from him, we honestly didn't agree with the diagnosis. He did not appear septic, and had none of the markers of SIRS. Chatting with the wife revealed that he's had a functional decline over 3 months. ED found a frigging dead cockroach in his ear. As a mere med student, I think it's a more insidious cause than sepsis in a patient who doesn't appear septic.
When we tried presenting the case to our consultant, we got brushed off as he was busy on that day. And he just bought the whole sepsis story hook, line and sinker (stinker?) without giving us a chance to explain. Sigh.
At times, I really wonder what's the point of critical thinking if it's useless. It does shitall. So what if I suspect something else in a patient? Which consultant is actually going to listen to me? After all, the consultant's the one who takes the fall if shit hits the fans so who cares. And I'll just make my workmates hate me because I'd sound like a total smarmy bastard.
I guess it's a valuable lesson to learn. That politics is everything in a workplace... And incompetency has to be tolerated. Unfortunately, it kinda means that I'm of the opinion that healthcare here is going to the dumps.
Sigh. People suck. Life sucks.
12:17 AM
Tuesday, February 19, 2013
There are days when everything seems great and rosy. And then there are days when you just want to punch the living daylights out of everything, despite things actually going relatively well.
I guess today was more of the latter than the former, and might be attributed to the simple PMS syndrome. And maybe slight stress since it's week 5 outta 6 of my rotation and I still have 1 more assessment to get through, despite how I managed to get the other big one done back in week 3.
I just... Want to find a hole to crawl into and never come out again. People suck.
7:26 PM
Tuesday, February 12, 2013
I just had to blog about the momentous event of... The submission of my first project to a medical journal! *pops champagne* Tbh, none of this could have happened without DE's help, and admittedly my groupmates (even though I've had a few not-so-nice things to say about them, esp EB). Given the non-confrontational misanthrope that I am, I really dislike having human contact, and my groupmates have been there to give me the courage to send emails/make the necessary contact. Like how I had to kinda ask for SL's 'advice' on emailing the statisticians and FW to thank them (I was in a dilemma since I thought it'd be rude not to thank them, but at the same time felt that they'd think we were completely wasting their time with such an email).
And DE's been great; I can't imagine how much work he puts into research. He's done so much for us outside of his working hours, and we could never have gotten anything done without his help.
So yes, the year of the snake has gotten off to a great start! Having this project submitted for publication, nearly finishing off the assessments for a 6 week rotation by the end of week 3 (finished my 3 logbook reflections today, so just got my ward presentation left)... And also getting the options that I wanted! Gonna be doing ICU this term, and cardiac arrhythmias in my last term. My grand plans of going for a surgical option in term 4 were shelved after consideration of how I'd be wanting to run home to camp out in my mugger cave since it's during the last 2 weeks of the academic year (right before exams).
Cardiac arrhythmias should be a good revision for the OSCE too... Let's just hope I won't be expected to stay ridiculous hours for it! Would be good if I could self-declare a study break, like RL and I did for CNY today (we both didn't turn up at the hospital :P). And well, quite a few people have told me that I'm very suited to being a physician, so I guess I should give cardio a shot (have been warming up to it despite hating it in 1st year).
Alrighty, year of the snake; please play nice! Hopefully you'll be a year of productivity as you've been (and not a year of foolish optimism since I'm extrapolating what happened in a mere 2 days of the year to the entire year. Lol)!
12:23 AM
Monday, February 11, 2013
It's CNY today! I think the exclamation mark probably inferred more excitement than I experienced in the entire day. CNY here's pretty dull, and mainly involves being on the phone/computer to rapidly reply good wishes from friends/family. And of course, money from my parents XD.
It didn't help that I spent basically all of yesterday at work invigilating exams for the GP fellowship; I left home at 6.15am and got home at 7pm, utterly exhausted (exams are only twice a year or so thankfully). My mum had a nice steamboat dinner ready though, so I was kept happy despite the series of unfortunate events that had occurred en route home from the exams.
I was late by less than half a min (the train literally pulled away from the platform when I was about 10m from it) for the train, and had to wait a long 22mins for the next one. Of course, I had to miss the train when the next one was delayed (trains usually come at about 10-15min intervals). I then managed to lose my way trying to get out of the bloody train station that I'd parked at thanks to the massive construction that was going on, and got caught at the traffic light both times, causing me to be delayed by about 10mins. Then got stuck crawling behind some idiot that decided to travel at 10km per hour below the speed limit. And it didn't help that I worked on a day that I'd planned to have off. I'd cancelled piano teaching this weekend due to CNY, and just sheer exhaustion since I'd been running on a sleep deficit since getting home at about 3.30am from EB's birthday party last week.
Oh yes, EB's party. I'd initially intended to leave before midnight (got there at about 9.30 after piano teaching), but somehow ended up leaving at 3am along with a few others. It was quite dull initially (us meddies lounging in a corner chatting amongst ourselves while EB, 3 other meddies and her high school friends watched a movie in the living room. I was kinda thinking why I even bothered turning up...), then we played bang, which is this awesome card game. And then mafia after that, because EB doesn't know how to play bang, wasn't interested in learning it and proclaimed that it was her birthday and we should all listen to her. *cough*
I think I started looking a bit stoned by 1am, and just switched off by about 2. I was probably too tired to remove myself from the party, but all in all, it was pretty fun.
This week's been a pretty good/interesting week. Learnt quite a lot of weird stuff on the ward (e.g. Bartter's syndrome which I'd never heard of before, and the patient also had acute hep B. Saw a case of hepatic encephalopathy too), and hit 20 patients for my logbook despite it being just the end of week 3 now :P. I've also got my group presentation signed off (by none other than the consultant who got shitty at me last Fri. He surprisingly gave me a pretty good mark despite his high expectations and last week! I don't think he remembers what happened last week, so phew), so I've just got my ward presentation and 2 more logbook reflections to do (did one just now) and I'm done with gen med :D.
One of our bedside tutors (ND professor/associate dean) also made me lose quite a lot of my respect for him. We went to see this patient who got really bad cellulitis of the knee after falling into a drain in Bali. Despite the patient's vigorous verbal and physical protests (he literally dragged said professor's hand away multiple times), our dear tutor repeatedly poked this poor guy's obviously inflamed and excruciating knee to attempt to find 'a collection of pus'. Firstly, I didn't think that we were entitled to do it given how we aren't even a part of his treating team. Secondly, the poor guy was in so much pain, and told said tutor off repeatedly to stop poking his knee, dragging his hand away multiple times to boot. Lastly, dear professorhead proclaimed that the patient is a NARCISSIST after we left the room because he protested against having his very painful knee prodded by a retired rheumatologist and a bunch of useless medical students who would not have done anything to help him anyway. And no, professorhead did not even apologise to the patient. It was so bad that one of the ND students thanked the poor patient and walked out, with the rest of us hurriedly following in his wake.
I mean, if we could have done something to help the patient, fair enough. But no, despite all of us agreeing that a 1st gen cephalosporin should not have been used in aggressive cellulitis (IV tazocin would have been a better option imo), especially if the patient fell into a drain and could have a pseudomonas infection, none of us even said anything to the management team. So yes, I really didn't think any of us were entitled to poke the poor guy's knee. And apparently the patient is a very nice man who even allowed one of us med students to put a cannula in him. Not the narcissist that professorhead proclaimed him to be.
Ah well. We all have to play the game of pretending to be thoroughly impressed and grateful for teaching. I usually am genuinely impressed and grateful, but not this time.
Anyway, I've been feeling sleepy pretty early nowadays... Almost at little-old-lady bedtime (i.e. 11pm for me). And generally sleepy throughout the day too. I hope I'm not coming down with a virus or something (RL's fighting off a bad virus atm). And hopefully it's not something like narcolepsy either.
So with that, I'm off to bed. Happy CNY to anyone who still reads this floating piece of crap in cyberspace! :)
12:20 AM
Friday, February 01, 2013
Today was a pretty flat end to a pretty flat week overall.
I really think I need to work on taking criticism more constructively, except that it really shits me when the criticism isn't warranted in the first place. Unfortunately, the reality about medicine is that it's basically one gigantic political charade; even if the consultant feeds you what you know is bullshit, you still open your mouth, swallow it whole and smile while thanking His/Her Almighty for your daily bread.
And yes, I kinda got shot down by our consultant today. We all did at various points; I just didn't feel that what he said to me was right. There is a patient on the ward who was admitted with pneumonia on a background of CCF 9 days ago. We (RL and I) were there when she was first admitted, and are aware of her progress, probably more so than the ND student (ND being the other med uni) who presented the case today. Obviously the patient's D-dimer would be elevated due to her CCF... However, said patient also has a history of PE, and had a low-grade temperature a couple of days ago.
The ND student presented her as having lower limb cellulitis, which is possible but both RL and I didn't think the patient's limbs had changed too much. The consultant then criticised our team's decision to send the patient for a CT PA to rule out a pulmonary embolus, because he assumed (from a rather sketchy presentation admittedly) that it was done thanks to the elevated D-dimer. Unfortunately, I don't think the history of the patient having recurrent PEs was brought out very well, and the ND student wasn't really aware of how the patient presented.
I then kinda argued that the CT PA was warranted due to the patient's history of PE, as well as the fever. Moreover, DVT often masquerades as cellulitis, and cellulitis/thrombophlebitis can result due to DVT. The patient could also have a fever due to the PE, and already has underlying dyspnoea (not sure if there was an exacerbation). The consultant then shot me down by saying that it was obvious that it was an acute exacerbation of CCF (in actual fact, the patient had come in with pneumonia which the student had completely missed), and 'if it quacks, it's a duck and just call it a duck'. He then proceeded to say that PE does not cause fever (and repeated it twice). Which I personally think is wrong, and have been backed up by textbooks that I've since looked up.
I guess I wouldn't mind getting shot down if I think it's fair... But what I really hate is getting shot down because the consultant isn't open-minded enough to regard my arguments. I suppose the blame shouldn't be completely heaped on him since the only information he had was from the sketchy presentation by the ND student. However, it kinda means that I've started off on the wrong foot with said consultant, and it somewhat worries me.
I've never been great with politics. As RL and I were chatting, it isn't the brightest who end up with the best jobs. Using a crude analogy, medicine is like a reality show; the shitty singer who can get the crowd on their feet with their charisma wins the competition over the real songbird. Such is life, and I guess if I really want to do well in my career, I'm going to need to somehow mask my rage face and take criticism (fair or not) with a huge beaming smile.
Sigh.
On another note, DE smsed me last night asking about our data (apparently FW had asked if the data was really knife to skin time). After replying him, he replied with 'Are you able to chat?'. I nearly fainted. Being the non-confrontational hermit/misanthrope that I am, I really really dislike phone calls. I replied saying yes and that I'm also on my computer if he prefers email *massive hint*. Unfortunately, my phone rang about 10 secs after. Blergh.
It was really awkward given how his monotonous voice was rather undecipherable over the phone, and I was just hmm-ing and umm-ing a lot of the time. And honestly, I felt like he didn't really need to call me! He just mumbled about how FW says the knife-to-skin time kinda includes post-op dressing since she dresses the wounds as she goes, and so he'd have to take that bit out of our definition of knife-to-skin time. And then said that he was hoping to submit the paper today, and that FW seems happy with it, and that the biostatistician (the helpful one) had made a few comments he was addressing too. And that was it. Awkward much (this was about 9.30pm too. Gosh he's such a workaholic).
I'm just glad it's nearly over. The project's starting to feel rather stale, esp after the entire saga towards the end of the year (grades, working my ass off to get our stuff ready for the conferences etc). Also doesn't help that dear EB suggested for us to submit our project to an entirely unrelated research symposium; unfortunately our research has NOTHING to do with medical education. In retrospect, I think I got irrationally angry about it. I was angry on 2 counts; firstly, if she'd really wanted to submit it, she should at least read what the symposium is for. Secondly, she'd happily write it on her CV while I end up shouldering all the work as has happened in the past. It really shits me that she'd have the audacity to ask to submit it to the symposium when she had such minimal contribution to the project, and when she didn't even read what it's about, only caring for her CV. Despite the fact that nearly everything she's got on her CV was thanks to my hard work last year (and this year, with the publication). Again, I admit that it's quite irrational. I need to work on not getting so unreasonably angry; I guess it's just been a really long week and this is what accompanies annoying monthly bleeding/cramps/womanly pains.
If it helps, I wasn't openly angry about it...? Then again, I suppose this makes me two-faced. Whatever; my brain hurts and I shall spend my Friday night curled up in bed looking at my blank white bedsheets.
Oh, something nice did happen today though! I bumped into Sri (intern from my renal/gen med term last year. Basically the only light in an extremely dark tunnel) while waiting for my brother at RPH. My mum and I had gone to Harbour Town to use our $20 Fila vouchers, and were waiting to hitch a ride home from my brother. And then Sri walked past! And he actually recognises me! He apparently bumped into my brother a few times this year. And he's still the same, nice humble dude (who let me perform my first cannula on him. Glad I didn't give him septicaemia).
I'm now off to shower, then stare at my blank white bedsheets till I fall asleep (or read a book).
10:17 PM