DHAL: June 19-26, 2014

Hello friends! How have you been?

What a long absence, but here’s what I’ve been up to this past week!

Highlights:

  • As I mentioned in my previous DHAL, I spent last week in ICU and glad to say I enjoyed my entire time there. Unfortunately, I do think a week is too short. Just as I was getting used to the very different medical environment and getting to know the team, it was time to move on. Alas!
  • On Friday, June 20th, I made soft cranberry white chocolate chips! I think they turned out good and not too sweet with a hint of cinnamon.

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  • The next day, I accompanied FangYing (and her younger sister FangZee) in the morning to help her look for wedding dresses. I couldn’t stay with her for all her appointments because I had lunch at Matt & Kristen’s – thank you so much for the delicious food! It was lovely to see their family – Abigail gets bigger, smarter and more gorgeous each time I see her. Not only was it really nice to see my friends (James, Kim and Smiles), it was also really nice to meet some of their friends and catch up with some of the ones I’ve met in the past. Annette, who I first met through Kristen during our first year elective in Vietnam is 6 months pregnant already, how time flies!
  • On Sunday, I went with FangYing and her sister again to another bridal shop in Indooroopilly, where she also convinced me to try on a few wedding dresses. Although I’m not seriously looking for one myself yet, it was a fun experience! I definitely do not want a mermaid wedding dress and after trying on some strapless ones, I like them a lot more than I think! That’s all I got so far 😛 Afterwards, we met up with YungHowe, her fiance, for dimsum lunch – yummy! I’ve been craving for a while so it was quite satisfying 🙂

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  • It was a fun weekend that continued even into Monday when I met up with Sarah and Amanda for a girl’s night catch up. We had dinner at New Shanghai, left stuffed with the promise of doing it again soon. It was also Amanda’s belated birthday so Sarah and I had the chance to treat her to dinner.
  • My gorgeous friend Ruixi married her love, Chris, on June 21! So sad I couldn’t be there with them and friends, but she was a beautiful bride and they both looked so happy!! I’m so happy for you two! Love seeing the photos!
  • Starting this week until the end of this rotation – July 11th, I will be on Anaesthesia. This entails me accompanying a different anaesthetic consultant everyday to theatre in order to learn and assist. So far, I have been blessed with very friendly seniors who are happy to have a medical student and eager to teach and give me hands on experience. I am getting better at ‘bag and masking,’ which is the most important skill to learn in these next few weeks. I still lack the upper body strength to hold the mask and bag at the same time, but I’m working on it! Another skill we try to master during this term is intubation – which I’ve met with variable success – I accidentally put the endotracheal tube in the oesophagus today. My last intubation was perfect though, hopefully I keep it up!
  • The other nice thing about anaesthesia is the chance to see surgeries I haven’t seen in the past. For example, a total hip replacement, maxillary advancement, bilateral breast reduction, etc.
  • This morning, I got confirmation that I will have free accommodation during my 4 week elective in Nanaimo, BC – yay! Saves me at least $500 🙂
  • I finished at the hospital quite late today. It was already very dark outside when I got home but I saw an outline of a bouquet waiting for me at the door. I couldn’t look at it until I was inside but what a beautiful surprise. A bouquet of our favourite flowers – lilies from Michael – I love you! They haven’t bloomed yet but are so fresh and I can’t wait to see what colour they are. Thank you dear!

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Lowlights:

  • I need to start packing! 2 weeks left until I go home! So much to do still. I have 2 pieces of baggage on my flight back so I will be bringing back goodies for my family 😉
  • Long days. I’m exhausted and falling asleep around 10pm these days. This rotation is draining! Can’t wait for it to be over and to be going home!

DHAL: June 11-18, 2014

Hello friends!

Look at that, I didn’t even get through one month of DHAL and I already failed at daily blogging, oops!

The reason I haven’t been blogging is because I have been on shift in the Emergency Department and in the Intensive Care Unit (ICU) for the past 7 days straight and I’m so tired when I get home – with laziness and studying distracting me. I still have a couple more days to go before I can finally have the weekend off. My days are averaging 10-11 hours, which is quite tiring for a number of reasons:

  • You’re not getting paid.
  • You need to be alert and learning at all time, so it can be very mentally exhausting.
  • It’s constantly a different environment with new staff, protocols, and procedures to become familiar with.
  • You still have to go home and study or read up every night to at least look slightly competent.

With that being said, there have been a number of highlights and lowlights this past week.

Highlights:

  • Enjoying and finishing my 4 week stint in the Emergency Department. I quite liked the variety of presentations – from mild to serious and seeing how they are assessed and managed. Had a good time working alongside the doctors (especially the interns), nurses, and physios. Felt appreciated for my work and had a good performance assessment by a senior doctor at the end.
  • I finally had suturing experience! An elder man had a large wooden post fall on his hand which gave him a number of lacerations that needed to be sutured. My only prior experience was in theatre while the patient was still asleep, not awake and watching me. I’m happy to say that unlike before, I sutured with a steady hand, with proper technique and approval by my seniors. Patient was also happy with my handiwork – yay! Confidence restored, I thought I was going to have to live with a hand tremor exacerbated under pressure for the rest of my life.
  • And related to previous post, where it used to be nerve wracking to have someone scrutinize me while doing procedures, either someone junior observing to learn or someone senior watching to make sure everything went well – I am now quite comfortable performing underneath someone’s gaze. Phew!
  • Did my own plaster casts, on real patients! I know, it’s silly that I’m halfway through the end of my last year of medical school and only getting this experience now. Unfortunately, as international students, we do not get the opportunity to go on a rural rotation, which is where you get a lot of hands on experience. With that being said, I’m trying to make the most of all opportunities I come across.
  • This week, I am the only student in ICU when normally there are 2-3. Initially, I was a little intimidated to be the only student, especially in such a different medical setting without a colleague, but now I definitely feel privileged. I now have scheduled one-on-one teaching time with great consultants, who never make you feel stupid for not knowing all the answers. I was invited to stick with one team throughout the week and follow the same patients so I get the opportunity to learn how patients are managed in ICU – as opposed to being with a different unit every day. I’m also getting opportunities to see and participate in procedures and tasks I haven’t in the past, like maxillary antral lavage, bedside bronchoscopy, and transport of critically ill patients. It’s cliche, but I really am finding everything interesting. My days in ICU pass by quickly as there are a number of scheduled activities every day including: morning handover rounds, one-on-one teaching, radiology meeting, afternoon teaching rounds, etc. I always feel welcomed to ask questions, which is a good facilitator to learning as well. Only 2 more days!

Lowlights:

  • I am SO tired! Would’ve been nice not working for 9 days straight, but I guess that’s what the real world will be like when I’m working.
  • Not eating well. I’ve been averaging 1-1.5 meals a day, which isn’t healthy but I’m trying to change that.
  • The sickest patients are in ICU… and it’s hard to see them not get better. For example, we are caring for a young woman who had pneumococcal meningitis and developed sepsis following a microvascular decompression surgery for trigeminal neuralgia. She now has partial locked in syndrome – paralyzed from the mouth down, intubated and ventilated and could only communicate by blinking her eyes. After a couple of weeks (when I first met her), she began to develop fevers with an unknown focus, despite adequate coverage with antibiotics. All possible tests and scans have been performed with no cause for her fevers found. In addition, she has a rash that was getting worse before our eyes and right before the end of my shift today, she took a turn for the worse and became completely unresponsive – GCS 3. It’s not easy dealing with an unwell patient, but even harder when we don’t know how to help a deteriorating patient.
  • June 15 was Father’s Day, always a difficult day when my dad is no longer with us in person…

DHAL: June 8-10, 2014

Highlights:

  • June 08 – Starting a new show called The Blacklist. I’m really enjoying it and it reminds me of Alias, one of my favourite shows. A female protagonist, working for the FBI and a male antagonist (but is he really a villain?) with a unique relationship with the protagonist and a clearly deeper motive to his every single action.
  • June 09 – Saw X-Men: Days of Future Past with Sarah and Amanda, I loved it! I was also surprised to see Blink (Asian mutant who can create portals) played by Fan BingBing, an actress I grew up with for her role in the extremely popular Chinese series, Princess Pearl.

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  • June 10 – Good teaching sessions today. Ended the evening with a dinner from McDonalds. I know… I shouldn’t have.

Lowlights:

  • June 08 – Not getting much studying done because I was too busy watching the Blacklist 😛
  • June 09 – Had to tear up all the weeds in the backyard. Our landlord refuses to provide any gardening equipment and we will not spend our own money on such tools. Therefore, we have to tear them up by hand whenever there’s a house inspection or they make a big stink about it. A good workout, but wouldn’t need to do it if the landlord would do something about his backyard like the real estate agent said he would when we first moved in 3 years ago.
  • June 10 – Long day! Headache by the time I got home but ebbing with some Tylenol.

DHAL: June 07, 2014

Highlights:

  • My highlight of the day was easily having dinner at Kristen and Matt’s and seeing their little Abigail again! She is almost 6 months old and man, has she grown! Sitting up on her own and eating solids, time flies! It was also lovely to catch up with Matt and Kristen over some yummy tacos, cupcakes, ice cream, and wine! Will try to see them again soon 🙂
  • Was researching wedding stuff – exciting!

Lowlights:

  • Was researching wedding stuff – oh my god, we so poor! 😦 Haha!

DHAL: June 06, 2014

(Yes, I skipped DHAL for June 4th and 5th, sorry! I just didn’t find anything exciting or unusual to talk about)

Highlights:

  • Sleeping in… until 9am today!
  • Lunch date with Sam and catching up. I miss having him around to joke with like last rotation. He went to Wagaya for the first time today, and approved! Even treated me to lunch, although I was the one that took him, so thank you friend! 🙂 Glad he liked it because his girlfriend loves Japanese food, so now they have a new place to dine at.
  • Dinner date with Amanda, Sarah, Kee Ping, his girlfriend Janice, Xuan Ping, Aditya, and Daniel at Malaya Corner. So nice to see them all and catch up! Food was tasty and plentiful and conversation was not lacking – what I enjoy! Also ran into Clarence and his friend Andrew, so that was a nice surprise as well.
  • I baked today! The first time in a long time. I only bake when I can share with friends, like tonight. Trying to create a new chocolate cake recipe as well as a new choco-peanut butter icing and I think it was a success! Saved some for some special people I’m visiting tomorrow 😉

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  • Completed and submitted internship applications to Queensland, Western Australia and South Australia, 3 states in total. Now it’s completely out of my hands, I’m just praying that both Michael and I will be offered a job in the same city – that is our only wish.

Lowlights:

  • We haven’t sprayed cockroach repellant outside our house in a long long time. Now that it’s getting colder, the first one has finally made it’s way inside the house! Argh, so gross. It was about 1.5cm long and was too fast for me to kill… now it’s around the house somewhere and going to get revenge on me when I’m asleep. I guess it’s time to set traps. :(d

DHAL: June 03, 2014

Highlights:

  • When I was in Canada, one of my favourite cereals was Honey Bunches of Oats – Just Bunches! Randomly started craving that, so I looked for something similar at the grocery store. Guys, I found something even better: Jordans Crispy Oat Clusters – Chunky Nut

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Delicious! There’s just something about crunchy oat clusters… maybe because they’re flavourful with awesome texture and don’t get so soggy so quickly? And I was so impressed because there are tons of whole hazelnuts, macadamias, pecans, and brazil nuts. I know right? So many awesome, expensive nuts in a cereal box – who would’ve thought! Delicious with frozen fruit and yogurt!

  • I came across a really good Vietnamese singer I’ve never heard of before – Hoang Thuc Linh. Really great, mature vocals and she really does older Vietnamese music justice – I don’t really know many younger singers who embrace the genre.

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  • I came across this English proverb on Instagram today, “A smooth sea never made a skill sailor.” It made me think back to the rant I wrote yesterday. Although frustrating at the time, every experience, even difficult, can teach you to be a better person.

Lowlights:

  • Still having difficulty finalising my personal statements for internship applications that are due this Friday!

DHAL: June 02, 2014

Highlights:

  • Having a filling breakfast before starting the day. Doesn’t often happen on a day when I’m working!
  • Video chatting with Michael who’s now in Vancouver and staying with my sister, so getting to see and talking to her too!

Lowlights:

Similar to May 30th, I was rostered to sit in on another 4 hr teaching session for the junior doctors (interns). Seeing that I was sitting away from the main table, the interns told me to join them and participate in order to “actively learn.” The module for this session was abdominal pain, which is a very common presentation with numerous causes from simple to complex. Unfortunately, I felt the consultant who ran the session was quite demeaning towards me and by the end of the session, I was infuriated. I remember 3 distinct moments:

  • Someone has come into the emergency department with severe abdominal pain. What kind of pain relief would you consider giving? You would want something strong and quick acting, a reasonable choice is intravenous morphine. The consultant pointed me out and said, “You… maybe others, are probably thinking of the WHO ladder.” I wasn’t, it would be nice to ask me rather than imply. The WHO ladder is more for the management of chronic pain, starting with simple analgesia like Tylenol/Panadol + Ibuprofen and working up to stronger pain killers like weak opioids and then strong opioids. Of course you would not use the WHO ladder in this acute setting, I know that.
  • We then talked about pelvic examinations. Which includes a speculum exam (like when you get a pap smear) and a bimanual exam – when you use your fingers to feel inside a woman’s vagina, trying to palpate their uterus and ovaries for any masses or tenderness. Again, he pointed me out saying, “You’ve probably done one or two? Like during the training session with the volunteers?” Then without giving me a chance to reply, continues speaking. I was dumbfounded. Yes, we were given a training session and had the opportunity to practice on volunteers… back in 2nd year. By now in 4th year, I’ve had the opportunity to do quite a number of exams, even felt pathology. But… thanks again.
  • The last and most upsetting. We were asked what bHCG levels are relevant when doing an ultrasound. After a few seconds of silence, I answered “1500 and 3500.” These numbers are relevant because they’re the cut offs for the sonographer to be able to see an intrauterine pregnancy via the vagina or abdomen, respectively. However, rather than simply saying, “Yes, why?” He responded with, “I can see you’ve done your reading.” No, I didn’t just do my reading, I have completed my OBGYN rotation, I know this because I’ve learned it and applied it clinically.

I work hard to learn because I want to be a good doctor next year. I want as much clinical experience and teaching as possible in order to help me to be the best doctor I can be. And if you want good doctors, then you need to treat final year medical students like the doctors you want them to be. You don’t treat them like first year medical students and/or assume they have no clinical experience or knowledge. Argh!

My rant of the day. Over.

 

DHAL: June 01, 2014

Highlights: 

  • Start of a new month!
  • Thought I lost/forgot my daily sign off sheet for this rotation but it was just left in the Emergency Department AND it wasn’t thrown out!
  • Actually being told to go for lunch today by a senior doctor. And then talking about Canada to the same doctor because he is interested in taking his family there next winter so his children can experience snow for the first time.

Lowlights:

  • Severe abdominal pain waking me up late in the night that ended with me in the toilet for a long time. Don’t know if it was the Subway I had for lunch or food from New Shanghai at dinner with Christine. She was fine though at least, which is good!

DHAL: May 31, 2014

Highlights:

  • When your shift passes by quickly than you expected
  • Catch up and dinner with Christine Q at New Shanghai

Lowlights:

  • Failing at inserting 2 cannulas in a row! Has never happened before and what a blow to my confidence! 😛