Night Ward Call

March 28 – May 1, 2016

5 weeks… 5 gruesome weeks of night shifts, being the only junior doctor covering nearly the entire hospital including: general medicine, general surgery, orthopaedics, cardiology, sub-acute geriatric evaluation, pallative care + oncology.

Let’s just say it was a lonesome time working mostly by yourself! Never another soul in the staff lounge when  you do have a few minutes to relax.

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There were many significant moments for me, including unexpected deterioration and deaths of patients, attending my first full-on resus (CPR, advanced life support – patient didn’t make it), managing many acutely unwell patients, etc!

One of the more fun moments – being approached by a nurse, “I don’t know what’s happening with this patient, but there’s all this blood on the floor after she’s gone to the toilet!”

My immediate reaction, “What?! What do you mean you don’t know?!” This was also right in the middle of reassessing a lady for a potential MET call. So the shift coordinatory (nurse in change) and I ran down to the other side of the ward to check on this other lady and was greeted by this wonderful sight:

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Don’t worry guys, she was fine! She just had a huge infected intra-abdominal abscess that was awaiting surgery when it finally exploded! She was actually feeling well with some of the pressure relieved!

So many memories from my 5 weeks on night ward call – it was definitely busy and sometimes incredibly stressful. But my medicine has definitely improved and I was happy for the experience.

Not to mention, I lost weight working nights and looked my best (ever) for our wedding! 😉

Moments of November 2015

November 07, 2015

Surprisingly a good handful of colleagues who also enjoy board games!

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November 12, 2015

A Christmas parade in the summer! We have never seen such a thing so took advantage of the evening off. Michael and I had dinner at Nando’s (always have to remind myself never to go there again… just don’t see the appeal!) right by the road the parade was passing through.

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Those poor possibly confused kids – we saw over 5 Santas in that parade! 😛

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Certainly nowhere near the extravagance of Christmas parades we are used to but still heartwarming to see all the participants in their vehicles and the families lining the streets to cheer and support!

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November 13, 2015

A farewell tea for one of our favourites – Dr Jama! A long term locum who was moving on to work in Brisbane – everyone was sad to see him go! He was the first supervisor I worked under as an intern and certainly one of the best first experiences as a junior doctor!

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Michael also had the chance to work with him, I think we are both on the same page! Sad to see him go!

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Lucky for us, since November, Dr Jama has since come back to work again as a medical specialist locum – hooray for us!

Oh, the Irony

When I first started working as a doctor in January of this year, I prepared myself mentally, emotionally and physically to be yelled at, and berated by my senior colleagues.

Haha, I know, that sounds horrible! Of course, I didn’t expect it to happen all the time, but after hearing some nasty horror stories, I would rather anticipate it than be taken by surprise. With that being said, I’m happy to say I’m approaching the end of my 8th month of employment and that still has not happened.

However, I have been yelled at. It was loud, terrifying, awkward, and made me feel like I had done something terribly wrong.

It happened during my first weekend shift at the beginning of the year. I was on Medicine, working ward call. I had just finished ward rounds with the consultant and met up with my colleague to see what other jobs needed to be completed. She asked if I could check in on a patient that she was just notified had gone into complete heart block. A precarious situation, I immediately went to see the patient. On the way, I was stopped by the nurse and given his latest ECG – he was back in 2nd degree heart block, no longer complete heart block.

The curtains around the patient’s bed were drawn and there were visitors behind the curtain. I could hear talking but could not make out what was being said. The health of the patient above all else, I excused myself and entered behind the curtain. I said hello, introduced myself to the patient and his 3 visitors, including his wife. I explained we had received a call from cardiology that his heart had gone into an abnormal rhythm and wanted to make sure that he wasn’t experiencing any symptoms of shortness of breath or chest pain. After a brief talk and examination, I was happy that the patient was clinically stable and apologised for the interruption. I told the patient that I would now go familiarise myself with his chart and have a chat with the senior and let him know if there was anything else that needed to be done. The patient and his wife said thank you and I excused myself.

As I reached the hallway, I heard a very angry, “Excuse me!” I turned around to have one of the patient’s visitors towering over me, 15cm from my face, who proceeded to yell at me at the top of his lungs, “Do you know how rude it is to interrupt a minister in the middle of praying?! How dare you! You should be ashamed of yourself!” Before I could apologise (again) for interrupting and explain that it was necessary for the safety of the patient, he stalked off.

I was shaking. Not because I was hurt, but because I was furious. How is it possible that an adult cannot treat another adult with respect and communicate more calmly?

Being yelled at, for the first time in my (short) career, by a Christian minister – OH THE IRONY. He who should practice what he preaches.

A few minutes later, I returned to see the patient, his family, and more importantly, the minister. Despite the fact that I stood by my actions, I wanted to apologise again if they felt I was rude. The minister was not there and the patient and his wife looked mortified. Both she and her husband apologised profusely for the minister’s behaviour. They said it was appalling and that they were so embarrassed. They agreed with my actions and thanked me for putting the patient first. I thanked them for their understanding.

And that, is the story of my first experience being yelled at as a doctor.

Intern year so far

Intern year has really been incredible so far.

Unfortunately, where writing and blogging used to come so easily to me, I now find it immensely difficult to sit down and make time for it, particularly on my days off! As a result, I have not been able to keep the promise to myself to blog regularly but I hope to share more of my work experience today 🙂

It seems like ages ago, but when Michael and I came back from our 5 week holiday in Canada (March 27), we completed our next 10 week rotation – Michael on Surgery and I on Medicine. In hindsight, second rotation passed by in a blink of an eye. I have always, and continue to absolutely love general medicine. The complexities of patient presentations, the intricacies of patient care, and the teamwork required with Allied Health to ensure patients are at their optimal level of function before going home. A great experience with wonderful teaching and support from all seniors.

Then, both Michael and I moved on to spend 10 weeks in Gladstone, 1hr20min away by car from Rockhampton, where Michael completed his rotation in Medicine and I in Emergency Medicine.

Now that, was an experience. Unfortunately, the ED was constantly understaffed with numerous new faces that came and went as locums. However, as a result, I gained a lot of independence and experience. It took a few days, but I got into my own groove and for once, felt comfortable handling anything thrown my way.

Here are some points I took away after 10 weeks of Emergency Medicine:

  • Recognizing a sick patient is sometimes difficult, but shouldn’t be. If the little details don’t fit a proper bigger picture, something is wrong. Trust your intuition. Never hesitate to present your concerns and get a second opinion, you will be surprised how often you are right.
  • I can totally handle paediatric patients – they are so much more trusting of you than I used to believe. You can easily win them over and make them feel at ease, even in hospital. That stethoscope they don’t want you touching them with? Let them listen to their own heart and suddenly the room is full of giggles. And always have a lower threshold for concern when dealing with paediatric patients.
  • Lots of patients will come in for abdominal and/or chest pains. And sometimes, you just don’t find a cause for their symptoms and have to send them away. I’ve been pleasantly surprised to learn that patients will rarely be upset if you cannot give them the answers they’re seeking. The key is attentiveness and good communication. Listen to their concerns, investigate appropriately, rule out the dangerous causes, good pain relief, follow up plan, and safety netting are key elements.
  • Finally got some proper suturing experience! Thank you patients who don’t shy away from letting a junior doctor stick them with needles.
  • Presenting patients and making referrals used to take a lot more time and thought. Now it is almost second nature as I was constantly seeing and presenting patients to seniors in ED.
  • People break a lot of bones. Some people are huge wimps when it comes to pain, others are so stoic you may not even think they had a fracture. Kids are almost always excited to have broken a bone because it means they can get a cast!
  • So many young men come into ED post electric shocks at work.
  • If a patient who rarely comes in hospital presents to Emergency 4 times in the last month, and each time sent back home, something is not right. Be their advocate. Whether it’s a medical condition that needs more investigations or a home situation that needs more support – something needs to change or they will continue coming into hospital.
  • Keep a log of patients you see! Record procedures you’ve done, interesting patients you’ve treated, those you want to follow up. Future case presentations, continuity of care, and personal interest are only some reasons to keep a good record!
  • Working at a small, understaffed hospital unfortunately has its disadvantages: No formal teaching and less opportunity to participate in “real emergency medicine.” I did not get the opportunity to participate in proper resus or trauma situations. As a result, I’m sure I will be terrified and at a disadvantage when the situation arises in the future.
  • Never be scared to say “I don’t know” and never shy away from asking questions. That is how you learn! Seniors would rather hear you don’t know and teach you, rather than hearing your pathetic attempt at pretending you know more than you actually do.
  • I don’t see myself doing Emergency Medicine as a career, but it is certainly an experience every doctor should have in their arsenal to be a better physician. As someone who wants to do GP, there was one observation I made: some of the terrible referrals from GPs in the community. Note to self: Keep that in mind on “How not to refer!”

And this past week? We started our 4th rotation, back in Rockhampton, yay! I have moved on to General Surgery (less enthusiastic “yay”) and Michael is in ED.

So far, I’ve survived! I’m back to feeling like a pen with legs, but I think the work load will pick up soon. Luckily, all the seniors have been more than pleasant and I haven’t been yelled at – always a bonus 😉 I have no inclinations of being a surgeon, however, as a GP, it would be good to have surgical skills for minor procedures under my belt. I have made that known to the surgical team and they are keeping me in mind, which I really appreciate! Day 2 and I was called down to clinic just to do a punch biopsy because of my interest in GP. I’m looking forward to the next 2 months on surgery, will keep you updated!

What’s it like being a doctor?

How’s your job? Do you like it? Are the hours crazy? Are the nurses nice? Are the surgeons mean?

Just some of the repeated questions I’ve received from family and friends since starting work as a medical intern. 😉

I was on the General Medicine ward for my first 5 weeks. Then we went on our annual 5 week holiday (which I’ll definitely tell you more about later) and now I’m currently week 8/10 of another Gen Med rotation. Where has the time gone?!

First day on the job… I knew absolutely nothing and no one, it was fantastic. (Not). I spent every day imitating a sponge as best as I could. Trying really hard not to look too much like a fool while absorbing everything I was seeing around me. Trying to remember patients and their issues, staff members’ names and their roles, which forms to fill and how, where to find equipment and leave specimens, etc.

It was exhausting. For the entirety of my first week, I got home, ate dinner and immediately fell asleep.

However, like many other tasks in life, I gained familiarity and through that, confidence. With time and experience, I’ve even built some competence! 😉 These days, not only do I leave work on time, I also don’t take work home with me AND I can stay up for hours after having dinner!

Some of you may have heard the saying, “Interns are just pens with legs.” The reality is, there is some truth in most medical stereotypes. I mean, we do have to…

  • Make sure the patient list is up to date
  • Write the chart notes during ward rounds and patient reviews
  • Fill out request forms, such as pathology, imaging, referrals, etc
  • Complete the discharge summaries

So yes, a lot of writing is involved. But can you imagine if this pen ran out of ink?

Who would keep people up to date with patient notes? How would patients get their required tests? How would GPs and other doctors know what happened to their patient and what follow up was required?

As the ones who spend the most time on the ward, and through the above roles, we often end up spending a lot of time with patients and their families. We are the first point of contact for nursing staff in caring for patients. We help to clarify questions and provide more information. We listen to and acknowledge concerns, even if only to provide a joke and share a smile. Not to say the senior doctors don’t do all the above and more, it’s still a rewarding experience for us junior doctors.

So yes, we are at the bottom of the totem pole. Some days you feel it, but most days you’re definitely an essential part of the team.

Orientation Week

January 12-16, 2015

Looking back, our one week orientation in preparation for our new job as medical interns went by in a blur. Was it useful? I sure thought so at the time. But when you have so much information being thrown at you with the expectation that you will remember everything – sometimes it feels like pouring water over a duck’s head… nothing sticks.

Important aspects I remember:

  • A chance to meet our colleagues, the other new interns – at social events as well as part of orientation. It’s nice to start a new job as (at least) acquaintances rather than strangers. Also a good idea to socialise when you’ve just relocated to a new city 😉
  • Meeting the staff of the Medical Education Unit (MEU) – they look after us and make sure we are alive and well… and still do!
  • Cultural Practice Program – an introduction to the culture and practices of those who identify as Aboriginal or Torres Straight Islander. Amazingly, I have never received such a talk through out medical school. Even simple knowledge like how their family hierarchy works can make a difference in the care of those patients.
  • Listening to a panel of 2014 interns sharing their tips – interesting at the time… but honestly can’t remember everything everyone said.
  • Skills rotation – refreshing our suturing, cannulation skills, etc.
  • Spending time with the previous interns on the ward we are rostered to. Good to get handover and tips. Would’ve been even better to spend more time with them getting hands on experience prior to starting our first shift.

Everything else… can’t say I remember much of it now. Not to say I didn’t find it useful at the time, but we really had to learn most aspects of our jobs on the go. Listening about how to do paperwork or order tests is never the same as going through the process of doing it yourself.

Then it was pretty much ‘hit the ground running’ on our first shift. Exhausting because you are so unfamiliar with everyone and everything. But by the end of first week, everyone gets the hang of things.

Do we become smarter? Knowledge-wise? …Maybe. Administratively? Most definitely!

People joke that medical interns are ‘pens with legs’ … sometimes, I don’t disagree! 😛

Joking aside, my first few months working as a doctor has been great. Impossible to sum it up in a single blog post but I hope to share stories in the future!

Graduation presents

December 21, 2014

After lunch at Wagaya, our families came back to our house to visit – a first time for my family from Perth!

In addition, our families took that opportunity to give us amazing, generous, graduation gifts – thank you so very much!

My mom gave us our gifts from my grandparents first – as they are the oldest and couldn’t attend in person – thank you Ong Ba Ngoai! We will put the money towards our future and wedding planning!

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I received a nice watch and card from Ong Ba Ba

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Thank you to Ong Ba Ut for their generous gifts – we will put it towards our relocation and setting up a new life in Rockhampton!

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A very special gift to Michael from his parents, a laminated card that his mom has kept safely for many years

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My mom is the best, as always!

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With the best card 😛

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She gave us each a Pilot retractable fountain pen

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Michael also got a beautiful dark purple DKNY tie from my mom, and I received 2 Pandora beads – thank you mom!

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Thank you to Di Loan for your lottery tickets! We were really hoping to win, but alas!

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Also a very special thank you to Ong Ba Hai (Ong Ba Ut’s best friends) and Nghiem for sending me cards and gifts!

Some family photos

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I also want to share the graduation gifts from Michael’s family! We received them on December 11, 2014, during our beach getaway at Noosa with his family 🙂

Aunt Patsy and Uncle Dan gave us a generous gift to treat ourselves out to a celebratory graduation dinner – thank you! It was really too bad that our graduation date was changed to a week later this year compared to previous years. Unfortunately, they couldn’t attend but I’m sure they had a great time on their cruise!

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Uncle Rick and Aunt Wendy gave us the cutest Christmas ornaments. They definitely went on our tree and will be on our tree every year!

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Uncle Jim and Aunt Brenda gave us the novel “Breathless” written by Dr Todd – a thoracic surgeon who performed many of Canada’s early lung transplant operations.

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Thank you so much to everyone for all your love, gifts, and kind words! Treasured forever!

Graduation – Family Photos

December 21, 2014

With no other graduation ceremonies taking place, the University of Queensland campus was beautifully quiet for our family to take photos at a leisurely pace.

Campus is beautiful with sandstone and green back drops. For just one camera, a tripod and me running back and forth in heels to set up – I think the pictures turned out pretty good! What do you think?

Some of my favourites 🙂

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My pretty mom!

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Who knew this day would come?

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And always take the opportunities for pretty photos! That’s my rule 😉

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Everyone was ready for lunch by the time we were done taking photos – off to Wagaya for Japanese food!

We had a made a reservation and had our private room, which was nice!

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Sake for everyone, right mom? 😛

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Very happy everyone loved their food! It’s one of our favourite places and we were really happy to share with our families

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After lunch, we came back to our place… more about that in the next post!

MBBS Graduation – we’re doctors!

December 20, 2014

After a long journey, MIchael and I officially became doctors – yay!

Our graduation ceremony took place at the University of Queensland campus and attended by Michael’s parents, my mom, Ong Ba Ba, and Di Loan.

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Micheal receiving his “diploma” and being congratulated by the Chancellor. You actually receive an empty cylinder on stage and receive a packet of documents, including your diploma/testamur once you leave stage 🙂

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My turn 🙂 I didn’t faceplant on stage, success!

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As with every university graduation ceremony I’ve attended, the graduates are asked to turn around, face the audience, and give our family and friends a standing ovation. To thank them for their never ending love and support, for helping us achieve our dreams, and celebrating with us. This is a moment of happiness for many students, but a bittersweet moment for me. Happy to have succeeded but with tears stinging my eyes, remembering my father who’s no longer on this earth to see his daughter graduate. I know he would’ve been extremely happy and proud 🙂

My Ong Ba was quite exhausted after the long ceremony

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With a class of over 400 people, you can imagine how crowded the campus was!

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Family photo!

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My biggest support

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My other half, my meant to be!

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We decided not to hang around for long as it was quite crowded and hot, plus everyone was tired, but we were able to grab a few photos with our friends on the way out!

With the lovely Sarah 🙂

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Josiah and his family are amazing people – so warm and gracious – will never forget their hospitality!

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Will be working with Chuan in Rockhampton in 2015! Woo hoo for getting jobs!

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Can’t forget these 2, Fiona & Smiley, PBL 25 represent from Day 1. Missing Christine (elsewhere), James (on his honeymoon) and Kristen (with her baby girl)!

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And of course, Tom!

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While getting our diplomas framed, we ran into Lauren!

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Woo, we did it!

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Part of the reason why we were eager to leave was because we had already made plans. My Ong Ba Ut couldn’t attend our graduation (not enough tickets) so we had decided to come back the following day (Sunday) to take some family photos together. We would dress up again and come back to campus to take photos at our own leisure. It would work out perfectly because our graduation was the last ceremony of the year so campus would be completely empty.

So with that plan in mind, we went back to my family’s apartment to celebrate!

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Lots of toasts!

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Lots of “1-2-3-Voooooo!” (1-2-3 cheers!)

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Michael and I had wanted to take our families out to dinner to thank them. But everyone was tired and we decided to get McDonald’s takeaway instead. With wine. Ended the day super classy!

Thank you again to all my family and friends for your love and support! Couldn’t have made it to today without all of you!

Final exams of medical school – 4th year OSCEs

November 22-23, 2014

As you may recall from my last post, we had our Surgical Specialties (orthopaedics and ophthalmology) exam on Nov 13. Following that, we had a week to prepare for our final exams of medical school – the dreaded OSCEs!

These are a set of clinical exams that test all the skills we’ve learned and honed throughout medical school. A variety of skills may be tested, including history taking and examination, clinical reasoning, basic/advanced life saving, investigation interpretation and response, procedural skills (venepuncture, blood gases, etc) and more.

We were told ahead of time that we would be rotation through 8 stations, each with 2 minutes perusal (to read your stem and collect your thoughts). 6 of the stations were 8 minutes long and the other 2 stations were broken down to 2×4 minute stations with related tasks.

Needless to say, we were stressed. We were incredibly stressed! The entirety of our medical school could be tested in 1.5 hours. Not only was there so much to know, but 2 of the most important rotations (paediatrics and obstetrics & gynaecology) we had completed first in the year, which seemed like so long ago.

My OSCEs took place on the morning of Saturday, November 22nd. The group of us sat in nervous anticipation waiting to start, trying to pass the time by chatting with our colleagues or doing some last minute reading.

I was allocated to the green team with 7 other students and we were soon escorted to our first stations. Facing away from the wall, the buzzers soon went off, signaling the start of our OSCEs. Everyone turned to the walls to read the stem (taped to the wall) of our first station.

Once the OSCEs started, they passed by in a whirl. Time flew and you were in and out of each station in what felt to be a blink of an eye. There was no time to rehash or even think about how you did in the last station because you were too busy giving it your all in the next. In less than 1.5 hours, it was over. The wonderful ladies coordinating the exam for my green team gave us big smiles and congratulated us before ushering us out to join up with the rest of the group.

The room was a buzz with students discussing the stations and their performance. Lots of happy smiles to have one last hurdle behind our backs, however, not without some caution that our performance in one or more stations may have been lacking. The director of the MBBS program shook our hands on the way out and asked everyone how the OSCEs went for them, a nice comforting gesture!

And since I might forget what my stations were in a few months time, I am going to record them here.

In no particular order unless specified.

1) This was my first station, which was a 2×4 minutes. Was given an ECG to report, which was SVT. Then also given some bloods to interpret (hypochromic microcytic anemia, likely due to iron deficiency). After interpreting the bloods, we were given pathology forms to request the blood tests we thought appropriate. This was almost a ‘gimme’ station as it was very similar to previous years, however, I was so nervous it definitely took away from my performance!

2) My second station was an 8 minute one. A few weeks prior to our OSCEs, we were asked to submit a clinical & procedural skills log – a report of the things we accomplished and to what level. At this station, the examiner looked through my log and asked me questions seemingly to verify our stated level of competency. I was asked a number of questions, including, “Talk me through how to do an IV cannulation. What complications could arise? How do you do an ECG? What gets printed out on the tracing? What are leads V1-V6 called? If you walked into a room and someone was unconscious, what would you do? And how do you do chest compressions? How do you perform ophthalmoscopy?” Nothing the examiner asked was out of my comfort zone and I just continued to answer his questions until the bell rang.

3) A young male fainted while gardening. Tasks are to take a history, examine and manage. Was greeted by the examiner as I came into the room playing the role of a nurse, with an unwell patient on the bed. Turned out he was in anaphylactic shock and required acute resus and further management once he was stable.

4) An expected death in a patient with advanced bowel cancer. Had to do a death certification, talk to the spouse and write up the paperwork.

5) Preadmission talk to a patient for an anaesthestic assessment. The main finding in his history is a mechanical valve on warfarin therapy. Would need heparin bridging and antibiotics.

6) Giving a distraught lady the results of her hysteroscopy D&C, which was thankfully not cancerous but endometrial hyperplasia. Talk to her about the risks of endometrial cancer and treatment options for endometrial hyperplasia.

7) Taking a history and presenting a mental state exam of a patient experiencing acute psychosis, likely schizophrenia.

8) My last station, another 2×4 minutes. First task was to interpret a chest x-ray which demonstrated lobar pneumonia and then to write up the medication chart.

Overall, the OSCEs went well. At every station, I can still to this day, think about things I forgot to say, things I should’ve done and things I could’ve done better. I just hoped that the examiners felt I performed well enough to pass overall!

Last 4 weeks of medical school – Orthopaedic Surgery

October 20 – November 13, 2014

Ending medical school with a specialty I had been dreading… Orthopaedic surgery. Crazy hours, macho surgeons, and an intense knowledge of anatomy required were only some of the things I had been warned about.

Needless to say, I found none of the above true and in fact, extremely enjoyed my ortho term. There were 5 other students in my group and we were based at a smaller hospital especially known for elective hip and knee replacements. We were split into smaller groups of 1-2 students and assigned to an ortho surgery team. There were 3 doctors on my team, a consultant, a senior registrar and an intern – and I was very appreciative of each person, in particular, our consultant.

He started every face to face encounter throughout the day (even after coming back from lunch) with a smile on his face and the words, “So, did you do any reading? What did you learn? Why don’t you tell me all about it?” In response to our answers, he would ask us questions and provide us with more teaching. He was always kind and non judgmental, even if you didn’t know the easiest answers. His continuous interest and support in our learning was the push students (like myself) sometimes needed to really become interested in what we learning. Although the registrar had a different style of teaching, he was the same. There was never any time we spent with our team, whether that be in clinic, in theatre, or even on coffee break, that we didn’t gain more knowledge.

Even though I am not interested in pursuing surgery, for the first time in a long time, I felt useful and wanted in theatre. The team would encourage us to come to theatre and rather than leave us to watch silently and awkwardly in a corner (the bane of medical students’ existence sometimes), we were always asked to scrub in and assist. Even if we weren’t assisting, the team would continuously ask questions and teach during the surgeries, which was great.

I really thought Orthopaedic surgery would be my least favourite rotation, especially with less interest in surgery and my subpar anatomy – but I have to say, these last 4 weeks of medical school have only bettered the two. I’m looking forward to my surgical terms next year when I’m finally working and I have to say my anatomy is heaps better now!

My last rotation ended with 2 MCQ exams on Nov 13 (a day earlier due to the G20 public holiday) – one 50 question ophthalmology exam and another 50 question Orthopaedic exam. Despite walking out of the exam with the trembling thought of, “Oh my god, that was so much harder than I anticipated,” I’m happy to say that our results have seen been released and I got an excellent mark – so stoked!

We didn’t have time to lament awaiting our surg exam results though, as we had OSCEs to study for, which I will talk about in my next post 🙂

2 weeks on Opthalmology

October 6 – 17, 2014

My two weeks on ENT was immediately followed by two weeks on Ophthalmology. Without very little prior exposure to this specialty, you could say I was certainly a little stressed! However, my concerns were proven to be completely unwarranted. We were rostered to work in a variety of environments, each welcoming with its own learning objective.

The majority of my time was spent in the Eye Casualty Clinic seeing patients with acute illnesses like infections, foreign bodies in the eye, pain, etc. We also reviewed quite a number of follow up patients. Being in Eye Casualty allowed us to learn and hone some critical skills including how to take and document an opthalmology specific history, how to measure intraocular pressures, more practice using a slit lamp (with lenses) for indirect ophthalmoscopy and using a fundoscope for direct ophthalmoscopy. In addition, we also had the chance to see more specialised tests using machines such as optical coherence tomography and wide-field retinal imaging using Optos. Many thanks to the doctor in Eye Casualty for giving us much of your time teaching us!

We also had the opportunity to spend time in theatre, where I had the chance to see procedures such as an orbital decompression for Graves disease, ocular biopsy suspicious for cancer, and of course, cataract surgery. Although it may seem mundane after watching it more than 5 times, intravitreal injections are an important component for treatment of diseases that affect the retina, such as macular degeneration and diabetic retinopathy. As someone who is interested in General Practice, I especially appreciated learning how to identify and refer ocular emergencies.

And to end my brief blurb about my time on ophthalmology, here’s a photo of my (currently) healthy looking retina!

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2 weeks on ENT

Sept 22 – Oct 3, 2014

My two weeks with the Ears, Nose & Throat (ENT) team flew by very quickly. As part of my Surgical Specialties rotation, I chose to do my 2 weeks surgical elective in ENT for more exposure to a field that comprises a significant proportion of GP consults – particularly because I am interested in General Practice.

It wasn’t, however, exactly the experience I had anticipated. Fully expecting to see a lot of ‘bread and butter’ stuff (ear infections, sinus infections, etc), I had forgotten that as a tertiary hospital, we also saw all the rare and serious presentations. During the two weeks, I was lucky to have had the opportunity to meet and learn from many patients. From being on ward rounds, participating in clinics and attending theatre, I saw simple conditions from sinusitis, Meniere’s disease and ear infections to inverted papillomas, cholesteatomas, and serious cancers of different types and stages.

I worked alongside a great team who were keen to have students and willing to teach – so I learned a lot, and quickly! In addition, our team made it clear that they remembered what it was like to be a student. They were happy for us come and go as we please, to use our time as we saw fit. Thanks ENT team!

My Cardiology Elective experience in Halifax, NS

August 18 to September 12, 2014

After my Geriatric Medicine experience in Nanaimo, BC, I continued my medical elective adventure with 4 weeks of Cardiology in Halifax, Nova Scotia.

I will be forever grateful to Matt (Mike’s best friend) and his wife Laura for allowing me to stay with them and their daughter Isabelle during my 4 weeks in Halifax – thank you so much again guys!

I chose to do Cardiology because I wanted to become more confident as it has never been my forte and is so important within any medical specialty. I was lucky to be allocated to the Inpatient Cardiology Consult Service for my elective, which is a team who oversees all cardiology referrals for inpatients at the QEII and a number of other sites including Victoria General, Rehab, Veteran’s Memorial, and Abbie J Lane. It was a great opportunity to see lots of patient presentations, visit different hospital sites, and interact with numerous staff.

The consult service team consisted of a staff member (cardiology consultant) who rotated every 2 weeks and a resident (registrar). As you can imagine, it’s a pretty small team to take care of all inpatient cardiology referrals across numerous sites. There were some rare slow days, but most were extremely busy with continuous consults and follow ups.

I thoroughly enjoyed my experience on consult service! My responsibilities included: seeing new consults (full history and exam) and presenting them to the team including an impression and appropriate plans, communicating with treating teams and multidisciplinary team members, administrative work (writing notes, filling forms and orders), following up with investigations and plans, etc.

I had the opportunity to work alongside the same resident (4th yr anaesthesia) during the entirety of my 4 weeks, which was great. He was smart, friendly, and always willing to teach and provide guidance. I don’t think I would’ve enjoyed the experience nearly as much if not for him. I also had the chance to meet and work with 3 wonderful cardiology consultants – each with their own style and method of teaching and all of whom provided really positive feedback on my performance. They also offered to help me out in any way I needed (including being a reference), without me asking, thank you so much! 🙂 I worked as hard as I could, which was appreciated and validated, yay! Not to mention all the wonderful patients and other staff members I met and learned from throughout the 4 weeks. Heart failure, arrhythmias, myocardial infarctions, endocarditis, pericardial effusion/tamponade, etc.

Thank you to all the people I met and worked with, who were so patient with me and taught me so much! I hope to have the opportunity to see and work alongside you again. 🙂

My Geriatric Medicine Elective experience in Nanaimo

In summary, it was a wonderful experience for many reasons but primarily because I had a great preceptor. I may have previously mentioned, he is a one-man-geriatric-team who previously trained and worked for years as a GP. He does all the hospital geriatric medicine consults as well as see patients in his own clinic, so I had the opportunity to work alongside him and in both environments.

He was an excellent teacher, he was never impatient with me or colleagues or patients, and always provided good learning opportunities. I especially appreciated that he trusted me with his patients. He believed in my skills, and where they were lacking he helped me develop them. I saw many patients on my own and he always listened to my assessments and trusted my findings and judgement. Due to this, I felt I had the opportunity to thrive and become more confident.

Many of his long term patients said I was very lucky to have him as my supervisor and I do not disagree! His patients loved him as a doctor because he was always comprehensive, understanding, and willing to give as much time as needed.

Through this elective, I also had the opportunity to experience many ‘firsts’ in medicine. Here are a few I would like to share:

  • My first unexpected death. I was sent to see a patient who we were asked to consult for query MI (heart attack). He also had leukemia (terminal, not being treated) and hyperviscosity syndrome. When I came in to see him, he was sweaty, complaining of hard-to-explain discomfort, and extremely restless. He kept changing positions from laying to sitting up in bed. He was a little breathless (oxygen saturations in the high 80s to low 90s) but alert and speaking in full sentences. With his history and symptoms, I immediately wondered if he had a pulmonary embolism (clot in the blood vessels of the lung) instead. On physical examination, my main finding was bilateral costovertebral angle tenderness (often a sign of kidney inflammation/infection) which could also explain why he was in such restless pain. After a few short minutes, he began to quiet down. He laid still in his bed and appeared quite comfortable. I asked him how he was feeling and he said he was feeling better. He think told me to come closer and said, “You know, I have leukemia. And I know, I’m going to die. But it’s okay, I’ve accepted it.” Right after he told me that, he began to have difficulties speaking, opening and closing his mouth but no words would come out. Then, within a span of 3-5 minutes, his blood pressure dropped, he became completely unresponsive, and his GCS (Glascow Come Scale – neurological scale that measures a person’s state of consciousness) went from 15 (max score) to 3 (lowest score possible). His pupils became dilated and asymmetrical. It was just myself and a nurse with him at the time and he was DNR (do not resuscitate). The nurse asked, “What would you like me to do?” I felt so utterly useless because there wasn’t much I could do. I suggested pushing fluids to hopefully get his blood pressure up and agreed when she asked if we should send for blood gases. On previous imaging, he had progressive, chronic subdural haemorrhages (bleeding under the skull, pressing onto the brain) and from his acute deterioration, he must’ve had a massive bleed or other cerebral event. I called my preceptor who arrived within a few minutes and agreed there was nothing more to be done. He died within the hour. The shock of having someone unexpectedly crash on me and feeling so powerless to help was a very new experience to me, and the patient passed away. I had to sit in silence and digest afterwards for at least 15 minutes before moving on with my next task. My preceptor was quite understanding. “You get used to it,” he said, “but it never gets easier.
  • Haemoptysis. The coughing up of blood from your lower respiratory tract. A term I’ve read many times in books. A question I ask all patients with a cough, however, aside from some blood tinged sputum, I have never really seen. We were on call and asked to come see a lady who had a 2 week history of coughing up blood. She was also a First Nations woman and had a previous exposure to Tuberculosis (TB). In addition, she had Takayasu’s Arteritis – an inflammation of the large blood vessels that particularly affects the aorta and its major branches (to the brain, arms, etc). This vasculitis had affected her so much and she had had such extensive previous surgeries to her blood vessels that she now only had very limited blood flow to her brain. If anything were to happen and her heart didn’t pump blood effectively, it would affect oxygen delivery to her brain and she likely wouldn’t make it through without severe brain damage. A lot of interesting factors in this lady’s presentation. While getting a history from her, she started to develop a gurgle in her chest and started to cough, and cough and cough. She brought up bright red blood, even big blood clots. It was the first time I had ever seen true haemoptysis. Not a sight I will soon forget. Throughout her hospital stay, her cough and bleeding eventually settled down, her cultures never came back TB positive and she was eventually freed from isolation. She had a bronchoscopy (a scope to look down the lungs and take samples) which didn’t come back with any sinister findings, like cancer. Whatever caused the bleeding remained a mystery but she left hospital happy and symptom free and promised to return for follow up!
  • Met a man in emergency who had a STEMI (heart attack with characteristic ECG changes) that completely resolved after thrombolysis treatment on ECG. Then it came back! Definitely had to quickly transfer him to the closest facility for PCI treatment!
  • Encountered a pulsus paradoxus (abnormally large decrease (>10mmHg) in systolic blood pressure and pulse wave amplitude during inspiration). This lovely 90yo lady had presented with 2 weeks of increasing shortness of breath and 2 syncopal (fainting) episodes. The doctors who saw her thought she was having heart failure and was fluid overloaded so gave her diuretics and sent her for an ECHO (ultrasound of the heart). Over the course of the day, she became delirious and her ECHO came back with unexpected findings. She had a large pericardial effusion (blood in the sac space around the heart) which was causing a tamponade effect on her heart. Needless to say, once the effusion was drained, she immediately felt a million bucks better. Apparently, I probably won’t come across such a significant pulsus paradoxus again anytime soon in my career.
  • Had a lovely patient who had come in with severe sepsis but also had an ongoing history (years) of hallucinations. They always occurred around the time he fell asleep. They were never threatening but he described them with such amusement and laughter that of course, I joined in. “Oh yes, I see animals all the time. Today, I had a baby goat on my pillow” and “I see birds fly around chandeliers when I look up at the empty ceiling” and “I’m always reaching for coffees and food that are not actually there” and “When I watch TV, I will see another TV screen beside mine playing something else.” Incidentally, he was also found to have liver cirrhosis, splenomegaly, and abnormal blood results (significant of a developing haematologic malignancy) so there was that interesting aspect of treatment and management as well.
  • Had a 90yo lady with such severe aortic stenosis that she was no longer able to get out of the bed without being breathless. She didn’t want invasive intervention but what really stood out for me was her passion in life. She was an avid hunter, baseball player, and loved fly fishing.
  • Did my first trochanteric bursitis local anaesthetic/steroid injection. Probably one of the most easiest procedures I’ll ever do in my career but it was exciting and provided immediate relief for the patient.

Those are just a few of my experiences on my Geriatric Medicine term, I’m sure I’ll remember other ones I’ll want to share! One of the things I enjoyed most about this elective was the complexity surrounding each elderly patient, very rarely are they simple cases. Patients had cardiovascular disease, lung disease, dementia, mobility limitations, falls, frailty, diabetes, incontinence, no social support, etc. Their medication list hadn’t been reviewed and they were on too many or not enough medications. Physical examinations had to be comprehensive – I often did a cardiovascular, respiratory, GI and neuro exam on every patient – and often found incidental but important findings! Some findings include: postural hypotension or gait disturbances that could’ve accounted for falls, heart murmurs not previously mentioned, enlarged liver/spleen, etc. Even though at times it can be overwhelming, it was very rewarding to tease out all the pertinent information and use it to create an all encompassing plan of management.

The best surprise of my elective? My preceptor telling me that he would be on vacation during my last (4th) week on elective and offering me a ‘self-guided learning week’ if I wanted it. The opportunity to go home and spend an extra week with family in Ottawa? I told him that it would be a cherished opportunity, as long as he felt I had worked hard enough and was functioning at a level to deserve it. Yep! And backed up by a good assessment and an agreement to be a reference for me. So happy!

Even though it cost me an additional $400 (I know, it’s ridiculous) to change my flight, it was worth it. My sister was also back in Ottawa from Vancouver, so we had a complete family and quality time together. I was very grateful for this extra time with family as I really don’t know when my next opportunity to visit Canada will be.

Thank you to my preceptor, the hospital staff, and the patients I met for making my geriatric medicine elective such a great learning experience!

“Hi. My name is Sandra and I don’t update my blog”

Thanks Amin, for pointing out the obvious 😛

Hello again readers! It’s been so long, I think my DHAL (Daily highlights and lowlights) series is officially a flop! However, I will still continue to write DHAL posts when the opportunity arises.

I do have quite a few things to share on this blog since my last post including: my geriatric medicine elective experience in Nanaimo, my surprise week in Ottawa, and starting my cardiology elective in Halifax. Please stay tuned! 🙂

DHAL: July 29, 2014 – Best news ever!

(Note: Sorry, this is going to be a long post because I want to document this part of our journey)

As some family and friends may know, the last few weeks have been incredible stressful for Michael and I as we held our breath and waited for potential job offers for next year.

Since some of you may be unfamiliar with how the Australian system works, let me try to summarize it:

In Australia, the medical degree is called an MBBS (Bachelor of Medicine/Bachelor of Surgery), not an MD like North America. They are, however, equivalent. Both countries have a 4 year program with the first 2 years being course based and the last 2 years being clinically based in hospitals.

Once you graduate, however, it’s quite different.

In North America, you apply to the residency program (specialty training) of your choice in your last year of school, in order to start shortly after graduation. These training programs range from 2 years (Family Practice) to 4-6 years for other specialties. Once you are done your residency, you might chose to do a fellowship(s) to become even more specialized.

In Australia, once you graduate, you must complete an internship year before you receive your full registration. This year consists of 5 rotations: general medicine, surgery, emergency medicine and 2 electives. Following intern year, many doctors do a Junior House Officer (JHO) followed by a Senior House Officer (SHO) year in order to gain experience and get to know seniors in their field of interest before applying to a Registrar Training Program (equivalent to the North American Residency program). The length of the Australian training programs are about 2 years longer, with General Practice being 4 years. Overall, the training takes a few years longer in Australia vs North America.

Now that you know more, here is our story. Both Michael and I want to stay in Australia after graduation and complete at least our internship year. For that reason, we have not completed all the required exams in order to apply for residency back in Canada this year. Depending on how internship goes, we would be more than happy to stay in Australia to complete our training. The problem was, however, where we stood when it came to applying for an internship position.

The state of Queensland has 6 priority groups (you can see them HERE), and jobs are allocated in order of your priority. According to the list, as Canadians studying in QLD, we are Priority 4 (P4). Unfortunately, there are not enough jobs for the number of applicants. Not only did both Michael and I want jobs, we wanted jobs in the same city in order to be together… what were the odds?

In order to apply, you had to preference 16 hospitals in Queensland from 1 to 16, #1 being the hospital you want a job offer from the most. Therefore, jobs are allocated first in order of priority, and second in order of preference. All Priority Groups submit their preferences by the same date. However, P1s get allocated their positions first. Once they have accepted or denied their offers, the remaining spots are finalized and published. At this time, P2-6s have the opportunity to submit a new list of preferences if they wish.

For example, if a P4 listed Hospital A as their first preference, but after P1s have been allocated their jobs, there are no spots left at Hospital A. He or she may choose to submit a new preference list topped with other hospitals that still have spots.

After a lot of thought and talking to our senior colleagues and friends, both Michael and I decided to chose Rockhampton Base Hospital as our first preference. We had read and heard first hand from many people that Rockhampton had many new and continuously expanding facilities, numerous educational opportunities, consistent workplace support, great teaching from senior physicians, and attractive intern to consultant ratios.

This was this year’s Position Status Report after P1s had accepted their offers and P2-P6 had submitted their second preference list. Note the number of intern spots remaining vs the number of P2-P6 who applied.

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There were 20 spots total available at Rockhampton. Luckily, it turned out not to be a popular hospital with the Australian students, with only 3 people who preferenced it high enough to get a spot. That left 17 spots leftover for the 63 (P2-P6) applicants who had listed Rockhampton first, slightly less than a 1 in 3 chance.

We had been told that unlike P1s, job offers for P2-P6s were not random. We would be specifically selected based on the (unknown) criteria/interest of each respective hospital.

What could we possibly do to increase our chances of getting an offer from Rockhampton? There were lots of rumours, but here’s what we decided to do:

  • We listed Rockhampton as our first choice during the first round of preferencing and didn’t change it. This showed that we were initially dedicated to them, and didn’t chose them first in the 2nd round simply because they had spots left over.
  • We made contact after submitting our application. If we hadn’t been in Canada, we probably would’ve flown up to Rockhampton to meet the recruitment team in person. Since we couldn’t, we emailed them instead – as a couple, which was different. We also didn’t just email them to express our interest. We spent a lot of time and thought putting together a package for their perusal. This PDF package consisted of:
    • A letter of interest. We expressed the reasons why we wanted to be together and work in Rockhampton, and that we would be fully committed if lucky enough to be offered a position. Canadians have been notorious in the past for accepting internship positions (that start in January), then abandoning their jobs in July when they receive acceptances into residency programs back in Canada. We knew it was a black mark against Canadians and wanted to make it clear that we had no plans of ditching our contracts and responsibilities.
    • Photos of us. If we couldn’t meet them, at least we could help them put faces to our names. We also didn’t send traditional headshots, we sent in photos of us as a couple, another difference.
    • Our CVs. We both had our own weaknesses when it came to our CVs, but it gave them a picture of who we were and what we’ve accomplished.
    • Our transcripts. Neither of us had the best transcript in the class, but we worked hard for what’s on it.
    • And lastly, our personal statements. In our application, we had to submit 2 statements: Tell us briefly why you would like to undertake your internship in Queensland or at a specific facility(s) and What are the critical career related experiences you want to pursue in your intern year? We put them in the package so they could view everything together at once, rather than having to look at our application, as well as this document.

These were the photos we sent in:

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  • We received a response thanking us for confirming our interest and were encouraged to ask any questions. We replied to voice our concern of missing a possible important phone call from them because we were overseas. We reiterated that we were very interested and asked if there was anything we could do on our end to ensure we wouldn’t miss out.
  • There was! We were told that the initial phone call is often made to clarify a few things. The problem with Canadians abandoning their jobs was mentioned and we were given the opportunity to answer the questions we would’ve been asked during this phone call via email, in advance. The questions were:
    • Are you still on track to graduate December 2014?
    • Have you completed the necessary requirements to be considered for an internship position in Canada?
    • Your intentions to commit to Rockhampton Hospital for the full year (at least) if offered a position?
  • We were polite and enthusiastic in all our correspondence, and replied to each email in a very timely manner. The officer asked for our replies to the above questions at our earliest convenience/ASAP and we replied within hours – despite time differences.

Soon Monday, July 28th came around, and I heard from my friend Amanda (who had also applied to Rockhampton) that they were starting to make phone calls. Not with job offers though, they were just asking for answers to the questions mentioned above. Michael and I didn’t receive a phone call that day, presumably because we had already given our answers via email, but we were still nervous.

Then came afternoon/evening of our July 29th, business hours of Wednesday July 29th in Brisbane. This was the day that Rockhampton offers were scheduled to come out. We waited with bated breath. Nearly 7pm my time (11pm Michael’s time) Amanda messaged me to say Rockhampton was starting their phone calls because she just received a phone call from them with a job offer. Congratulations to her, how freakin’ exciting!

But then my heart started pounding. I was FaceTiming with Michael and we were incredibly nervous and stressed. Would we get a phone call? Would it be just one of us? Would luck be on our side and we both get job offers? It was really agonizing.

Nearly an hour later, Michael couldn’t stay awake any longer and he had an early day ahead of him. We said our good byes and he went to bed with his cell phone beside him and volume on maximum in case he gets the phone call.

I was beginning to stress. There are only 17 positions to give away. Surely the phone calls do not take very long. It had been over an hour since Amanda got her offer, did we miss out?

I decided to log onto Skype and try calling my cell phone, just to make sure calls were going through. Yep, it was ringing (as 0000123456) through fine, I quickly hung up.

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Now I kid you not, literally 2 minutes later, my phone rings, from an Unknown caller. I picked up, “Hello, Sandra speaking.”

I don’t even know how to describe exactly how I felt in those next few minutes. Relief and happiness flooded through me as the officer told me she had great news and wanted to offer me an internship position at Rockhampton Hospital for 2015. I really almost cried. I immediately thanked her and told her how incredibly happy I would be to accept her offer. She explained to me that the official offer will be arriving by email in the next few hours and to make sure I respond to it by the deadline.

Before I could ask her if Michael had received an offer too, she said, “Now, I’m about to call Michael next. I have no idea what time it is for you guys over there right now.” I laughed and told her it was after midnight for Michael and he had just gone to bed but don’t worry, his cell phone was right beside him. She was so lovely, she even asked if it would be okay to call to call him at this hour. I said most definitely and that he would be thrilled to hear from her. I thanked her again and we hung up.

Less than 5 minutes later, my FaceTime rang and I knew exactly who it was. I answered to Michael’s beaming face (the officer had told him I received an offer too), we couldn’t believe it! We had beaten the odds, both of us had been offered a position at Rockhampton Base Hospital – our first preference. We were now a statistic – 2 out of the 17 available positions!

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We were so ecstatic and relieved. We both had a job, and therefore a career and our feet in the door towards our future! Michael said, “Now that we have jobs, we can finally start planning our wedding!” And how true!

The excitement kept Michael awake for a couple of hours talking to me before he could go back to sleep. The sleep deprivation no longer mattered once we found out we had jobs for next year! 😛

And that, is the story of the best news I’ve received since the start of my medical degree. Best belated birthday present too 🙂 I have since emailed my referees to let them know the good news and thank them again for playing a part in my future – they were super pleased for us as well.

By now, we have also heard from a number of our Canadian friends who didn’t receive a job offer in Queensland 😩 Emphasized for us again how lucky we are and fingers crossed for them that they will soon receive an offer from out of state or from the private sector (Commonwealth Medical Internships – CMI).

If you’re still here reading, then thank you for your interest and sharing this happy moment with me!

DHAL: July 19-25, 2014 – Week 1 in Nanaimo

July 19. After saying farewell to my sister in downtown Vancouver, I hopped on the bus to head to Horseshoe Bay Ferry Terminal. The bus ride took less than an hour and a one way ferry ticket to Nanaimo cost $16.25.

Beautiful views from the ferry terminal!

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I was on the Coastal Renaissance… never have I been on such a humongous ferry! I admit, I did get lost but I was impressed. Ended up making it to the top deck and… fell asleep for most of the ride over to Nanaimo 😛 I was exhausted with only 3 hours of sleep, I tried!

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Once we arrived in Nanaimo and with my luggage, I decided to grab a taxi instead of the bus. I don’t think I mentioned this in a previous post, but the hospital I’m doing my elective at has a 3 bedroom house that they rent out to medical elective students for FREE. I felt quite lucky to be able to save some money! I was dropped off at the hospital to pick up my house keys and then walked approximately 700m to my accommodation.

The house is spacious, with everything provided, including linen and household products. Even has a desktop computer and printer for tenants to use.

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There is a housekeeper who comes by every Tuesday to clean the house as well.

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I had a moderate sized room with a desk and closet, didn’t take long to settle in! There’s also a lock on every bedroom door, allowing more security when you’re in and out of the house.

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Pretty great internet provided!

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I ordered some groceries online the day I arrived and was too lazy to go exploring so I even ordered some Chinese take out for dinner. Lowlight: It was THE WORST food I’ve ever eaten, I don’t even want to explain it. Those in Nanaimo, never order from Sun’s Noodle Bar. Needless to say, not much got eaten and a lot was thrown out.

I spent Sunday at home, reading and relaxing. There wasn’t much to do around my neighbourhood and I didn’t care to go into the city. Sunday night my housemate came home, a really sweet medical student from Ireland doing an elective in Paediatrics.

Otherwise, I was just nervous for the start of my elective! Was hoping for a nice preceptor! Have never worked in the Canadian medical system before so didn’t know what was expected of me yet. Monday came quickly. I started my week with some PowerChart training – the online medical record system they use here. I then met the course coordinator and eventually my preceptor. I was expecting to be a part of a hospital team for my geriatrics elective. Turns out my preceptor is a one man team!

He’s great though. Extremely patient and never discouraging towards me. He lets me do as much as I want within my limits of comfort and learn what I want to learn. Always takes his time to answer my questions and teaches whenever the opportunity arises.

As you can imagine, elderly patients most often have a plethora of issues that landed them in hospital. These can include: dementia, delirium, instability, falls, cardiac disease, stroke, incontinence, infection, etc. I love geriatric medicine because it is so general that you always see a variety of presentations. History taking needs to be thorough and examinations need to be all encompassing in order to not miss anything in an elderly patient, especially when there can be so many causes to their issues.

On Mondays, Tuesdays, and Thursdays, we are in the hospital in the morning and at his clinic (about 5min drive away) in the afternoon. We spend Wednesdays and Fridays in hospital.

My first week passed very quickly. My days start later than I’m accustomed to. My preceptor often tries to make it in by 9am but he has 3 young children to take care of and drop off at different activities in the morning, so we often don’t meet up until 10am. I get to start my day at a good pace and have time to review patients before he gets in. The days pass quickly because we are so busy, I often don’t get home until 7pm and we normally don’t have time to take a proper lunch. Usually we work until we need to rush to clinic and eat our lunch during the 5 minute drive there. A one man team is busy busy!

So far so good though, I’m quite enjoying my time working! Don’t know if I’ll see much of Vancouver Island while I’m here, we’ll see!

My sister is coming for my first weekend here, to celebrate my birthday early with me, which makes it less lonely!

DHAL: July 04-12, 2014

A huge gap of DHALs, how shameful! This is going to be a long one!

Friday, July 4th… meant one more week of Anaesthesia before the completion of my Critical Care rotation! It was getting harder to see the end now because although it was so close, it felt so far! Since there was no final exam (aside from an online multiple choice exam I had already completed in week 2 of 8), I did not have to spend my weekends immersed in studying, I was able to enjoy going out and seeing my friends.

So on Friday after my shift, I met up with Amanda for dinner. There is a vegetarian restaurant in Fortitude Valley called Kuan Yin Tea House that Michael and I have been meaning to visit because we have heard good things and it is highly rated on Urbanspoon (96%). I was a fun night out with Amanda but the food was subpar, I’ll be writing a separate blog post for this later on!

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Next day on July 5, I finally had the opportunity to see and catch up with Josiah and Danya! They are living in Bundaberg this year, so we have not had a chance to hang out since coming back from Canada, but it finally happened! Weekends in Brisbane for them are always hectic but they had some time to pop over for a visit! And I was finally able to pass on a small wedding gift that Mike and I brought back for them from Canada, which only had to wait 7 months 😉 They even gifted us a nice bottle of wine as a belated engagement present, unexpected but thanks so much guys! It was so good to catch up and hear that they are enjoying living in a new city and being well looked after by the small Bundaberg community. They are liking it so much that they have decided to stay for Josiah to pursue his internship training… that’s saying heaps!

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Lowlight: My cousin, Hoang, from Vietnam who now lives in Brisbane with his wife, was supposed to come over for dinner on July 5th. Unfortunately, something came up and they had to cancel!

The following day on July 6, I had a photo shoot session with the Gibson family!

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This was the first ‘photo shoot’ of any kind I’ve ever done. Pretty much had no idea what I was doing, didn’t have any special equipment, and worked with kit lenses. Had a good time with Kristen, Matt & Abigail but too bad Abigail wasn’t her usual smiling bubbly self! I imagine having a big black camera covering my face might be a little intimidating for a 6 month old! Was able to get a few photos, even some smiling ones. I’ll have to make a separate post but here’s a teaser photo!

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Because my cousins never made it on Saturday for dinner, I invited Sarah and Amanda over for some studying and dinner on Monday, July 7! Had bought a bunch of ingredients to make dinner and didn’t want them to go to waste, what better way to use them up than to have friends help you? Made some Thai green curry chicken to have with rice, yum!

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Had also made lots of peanut butter chocolate chip cookies so sent the girls home with a bunch as well. What made the night fun was meeting Sarah’s boyfriend, Jay. After years of poking fun at her for having an imaginary partner (he has always been too busy to attend any of our events or get togethers), we met him when he came to pick her up. Mind you, it was completely dark outside so I have yet to see what he looks like in person 😛

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The weekend passed too quickly and soon I was completing my last week of the critical core rotation. I feel quite lucky to have had most, if not all, preceptors be very kind and willing to teach. It made for a very good learning environment and I never felt intimidated with any procedural skills, even when I failed them. There was always room to improve and my supervisors were always willing to make things work better for me.

It is also nice when your effort and hard work doesn’t go unnoticed. I was rostered for 2 days (July 09-10) on the APMS (Acute Pain Management Services) team, who are responsible for hospital wide consults for patients who require more specialised care for the managment of their pain. These patients can include those who have epidurals, regional blocks, or patient controlled analgesia (PCA). With only 2 days on the service, I made the most of it including being proactive in taking notes, chatting with patients, and handing over plans to nurses in charge. I’m not sure what the other medical students did during their time on APMS, but when I received the note (not required and squeezed beside the signature box) “Above and beyond the call of duty” on my last day and a number of verbal thank yous and compliments, I knew I had done well 🙂

Lowlight: I was told this last week of the rotation by the course administrator that she wanted me to make up time for 2 sick days I took earlier in the rotation. My last week, where I’m fully rostered, and she wanted me to make up 2 extra shifts last minute. I was not happy as we were never made aware of having to make up for sick time, isn’t that why you have sick days to begin with? After having a chat with her and explaining to her that the request was unreasonable in the amount of time I had left, she told me to have a chat with the respective professors of the Emergency and Anaesthesia departments. Bring them my work books and evaluation forms so they can assess if I have done work to their satisfaction and maybe they will let me pass the rotation without making up the time. Lucky for me, both professors were more than happy to let me off after having a chat and leafing through my documents. It was annoying and stressful before I was given approval because of the potential to fail the rotation, but I’m glad things worked out!

Soon, Friday (July 11) rolled around and I was super eager to finish my last day of work! I had been packing up and cleaning the house bit by bit throughout the last 2 weeks so I didn’t have much left to do before flying out Saturday morning. And to end the rotation on a good note, the anaesthetist of my last shift was awesome. He spent the first few hours of my shift grilling me and asking me questions non stop, explaining things along the way as required. When that was exhausted, we just chatted about life in general where he also shared some good advice for my internship year. By 2:30pm, he was showing me his wedding videos and because the same surgery had been going on since 8:30am, he asked me if I just wanted to head home. Early day on my last day? Heck yes! I could definitely use some extra time.

I went home, where I met up with Yoni. He’ll be renting out one of our bedrooms (Christine’s in the other one) so I just wanted to give him the keys and a verbal handover, including what food he should help us finish, which he’s always happy about.

I then headed back into the city to meet up with Mabel, Amanda, Sarah, and Xuan for a post-rotation hang out! We had a coffee catch up at Bonsai Botanika before heading to Maru for a yummy Korean dinner and finished the night with some delicious bubble tea at Gong Cha. I will be writing blogs for the respective restaurants soon! Lovely evening with good company to end my time in Brisbane!

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It was around 9pm by the time I got home, plenty of time to finish up my packing and cleaning. I tried to stay up as late as I could in order to sleep easier on the plane but by 3am, I had to lay down for a 3 hour nap.

Thanks to Christine for giving me a ride to the airport at 7 in the morning! and soon I was boarding Qantas flight 15 to Los Angeles. Boy oh boy was it not the best journey home, will tell you more in the next DHAL!

DHAL: July 02-03, 2014

Lowlights:

  • Yesterday I experienced the worst lowlight since starting DHAL. I was feeling quite down and sad regarding the anniversary of my dad’s passing and being alone at home made it even worse, I’ve never been alone on this day before. I cried many tears. But writing yesterday’s blog definitely helped me deal with my emotions, even if it brought back many many memories. Thank you to all my friends who sent me their love, it was very much appreciated!

Highlights:

  • Ran into Mabel after finishing my shift the past 2 days in a row! Nice to stop for a chat and a few laughs!
  • The flowers Michael sent me bloomed and are gorgeous! Thanks love!

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  • Even though I’m on afternoon and evening shifts this week, it’s nice being in emergency theatre when the rest of the operating rooms are empty and there are only a handful of staff on duty. Just nice and quiet… 🙂 Also, the tea room is always stocked with fresh bread (white and whole wheat!), butter, vegemite, and jams to make toast. A good pick me up when you’re feeling low on energy! Of course there is always coffee, tea, milk, juice and also a basket of cookies for some extra calories whenever you need it.

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  • Since coming to Australia, we have been buying the large tubs of yoghurt thinking that it was the cheapest option, especially when they’re on sale. Recently I learned that was a lie. And that regular priced yoghurt in individual servings is cheaper than large tubs on sale! Never again will I be buying tubs when I can be buying something cheaper, with more variety, and easy to pack for lunch!

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I know, my life is SO EXCITING! 😛

DHAL: June 27 – July 01, 2014

A few moments of my previous few days…

Highlights:

On Friday, June 27, Mabel came over to review some Obstetrics and Gynaecology cases. Good to go over things and happy that information is still fresh on my mind. Caught up over homemade dinner including cauliflower soup and banana chocolate chip bread! It’s nice to have people to cook for, otherwise I don’t feel the motivation to make food!

On Saturday, June 28, I finally met my cousin and his wife in Brisbane! He moved to Brisbane from Vietnam over a year ago but initially I didn’t know he was in Brisbane and then life got in the way. Fortunately, although I absolutely abhor his father for despicable things he did and said when my dad was sick, my cousin is a kind person and his wife is quite friendly and easy to get along with. I met them in Inala (home of Viet-town) where they spoiled me with a yummy dinner at Que Huong Restaurant in Darra. Food dishes included fried soft shell crab, abalone and steamed chicken with greens. I was glad to finally catch up with him and meet his wife! They took me by their place so I could see their home and was kind enough to drive me all the way home. I’ve invited them over for dinner this coming weekend, so looking forward to that.

Then the next day, Yoni and I went on an awesome food adventure. We decided on a budget of $40 each and I chose a few highly rated but cheap eateries in the Fortitude Valley area. We met up at 1pm, started with BBQ pork and duck at Golden Barbeque. On the way to the next restaurant, Jamroc – Jamaican Jerk Chicken, we made a pit stop at 711 for Krispy Kreme donuts. Stuffed after jerk chicken, we headed into the city so I could run a few errands. Deciding to talk a walk in the Botanic Gardens, our plans were pleasantly foiled when we found out the cinema in the city was still showing Edge of Tomorrow and we could get student priced tickets at $6.50. After an enjoyable movie and some time to digest, we picked up some bubbletea from Hazel Tea Shop and headed to Maru, our last stop for Korean dinner. A very fulfilling, weight gaining, 6 hours of eating and eating. I’ll definitely be writing some reviews for the places we visited – let’s do this again soon Yoni! 🙂

This week in Anaesthesia, I’m rostered for PM/evening shifts in the Emergency theatre. Things have been good, I get a nice long break in between afternoon and night surgeries to have dinner. I’m actually writing this blog post on my phone during said break 🙂 I have had the same senior registrar the past two days who’s been very kind, encouraging and keen to teach. He reminds me very much of the first intern I ever worked with back in the beginning of 3rd year. The kind of person I hope to be towards my juniors in the future.

I have caught up with one of my favourite shows – Supernatural. Glad to hear that the show has been renewed for a 10th season because I can’t wait to see what happens!

I believe I have finally finished all my shopping to begin my packing to go home. You’ll see what I mean in a few weeks!

Lowlights:

Being alone! Canada Day was utterly boring as it isn’t a holiday here and I spent it all day in theatre!

Wished time went by quicker when you want it to! As much as I’ve enjoyed this rotation, I can’t wait to finish and be on a plane home!

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: May 30, 2014

Highlights:

  • I passed my Obstetric & Gynaecology rotation! Woo hoo! Results came back last week, and if you didn’t know how I felt about the 3 consecutive days of exams, you can read about it HERE. I was genuinely worried about the possibility of failing and ended up doing much better than expected. Happy with my results and can now breathe and move on!
  • I was rostered to sit in on a 4hr teaching session for the junior doctors today. Couldn’t help myself from participating even though I think I was only supposed to be an observer but a great learning experience. Case based learning today on the topic of neurologic presentations to ED (syncope, delirium, altered mental state, overdose, etc) interspersed with clinical skills. I’m glad there will be teaching like this for me next year to help keep up with relevant knowledge and skills.

Lowlights:

  • Ending the day with a headache 😩

DHAL: May 27, 2014

Quite the uneventful day!

Highlights: 

  • A great teaching session alongside Lauren and Kee Ping given by the Medical Education Registrar at our hospital. Simple things that really drive home the point but exactly what we need to work as an intern next year.

Lowlights:

  • A pretty bad headache that knocked me out for a few hours.
  • It makes me sad to see family members not bother lifting a hand to help their loved ones in a health care setting. I don’t know if it’s because they don’t care or if they feel it is not their job/beneath them – but either way. I was assisting a staff member today (she was tiny) to change the sheets of a large elderly man. He had urinated on the bed and also had dementia, was delirious and agitated, and didn’t speak much English. Despite our struggle, his big burly son didn’t even try to assist, either physically or even speak to his dad to help calm him down. When we finally finished, he pointed to a clean urinal bottle, at his feet, that fell during the change of sheets and said, “Um, the urine bottle is on the floor.” Really, you couldn’t just pick it up? I know everyone is different and has their own reasons, I just couldn’t imagine being like that when my dad was very sick years ago and I was his care taker.

DHAL: May 26, 2014

Highlights:

  • Booked my (why so expensive) flight home! I will be arriving in Ottawa on July 12 at 6:55pm on flight United 3829 from Chicago! I will have a week in Ottawa before flying out to Nanaimo, BC for my first elective in Geriatric Medicine.
  • Completed most of my learning modules for this Critical Care rotation. Still a lot more studying to get done!

Lowlights:

  • Still not done my internship application. Although I have until June 6, I really need to bang out some really well written personal statements. Not only is there the worry of not getting a job next year due to lack of positions and being lower on the priority list because we are international students, it is also likely that Michael and I will not be able to get a job in the same town 😩 Thinking of the distance saddens me.
  • Paying this (8 weeks long) rotation’s tuition of $10,560. My approximate $500 000 debt by the time I’m done medical school is quite nerve wracking. Not to mention with Michael, we will have a combined debt of $1million or more! Is there anybody wealthy reading this blog who would be interested in financially supporting 2 hard working, soon-to-be junior doctors with a massive debt and a wish to get married and start a family?

DHAL: May 23, 2014

Highlights:

  • I get four days off in a row starting today! Which will be followed by 5×10 hour day and evening shifts back to back next week so I guess I shouldn’t be too happy too soon 😉
  • Facetime-ing with my fiance! How lovely it was to laugh with this handsome face 🙂

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  • Getting so much housecleaning done! Everything is sparkly clean!
  • Because I have the day off, I can wear my engagement ring! I don’t wear it to the hospital because I am constantly washing my hands and wearing gloves. So sparkly and makes me feel Michael is close to my heart ❀

Lowlights:

  • Apparently, my scalp got a little burnt during our time in Bali. I have disgusting looking dandruff now… hopefully it clears up in the next few days before I’m back at the hospital!

DHAL: May 22, 2014

Highlights:

  • Seeing patients with such a variety of presentations: atypical chest pain, infective exacerbation of asthma in an 81, acute shortness of breath in an otherwise quite healthy 93yo man, superficial venous thrombosis, domestic violence, etc
  • Running into my supervisor from my Medicine Rotation last year. To this day I still remember rounding with him and the team when he suddenly stops in the hallway, points to an orchid and asks, “What flower is this?” When I answered, he questioned me back with, “How can you tell? How do you know for sure?” Completely stumped, he finally satisfied our curiosity with, “Because it’s the only flower with one plane of symmetry” and continued on down the hallway. Such a lovely old gentleman who is a great teacher and well respected by students and colleagues alike.
  • Being told to go home early! So nice, even if it was only 40 minutes early. And I even got a lunch break today! The blessings… haha
  • A glorious nap after dinner

Lowlights:

  • Just after piercing the skin and successfully getting flashback on my cannula insertion for a patient, it fell out! I don’t even know how it happened, but I hate having to prick someone more than once. It was even worse because the first one was successful and I most likely left the poor man with a bruise. The patient didn’t complain and it wasn’t painful, just completely unnecessary, bleh!
  • Knowing I had more highlights to share but now they’ve escaped me. I need to start taking notes throughout the day so I don’t forget!

Obstetrics & Gynaecology: The wrap up

It’s only been 2 weeks since my O&G rotation ended but it already feels like ages ago.

Overall, I really enjoyed my time on Obstetrics & Gynaecology. I have to say thank you to the other 4, lovely students on my team: Darice, Sam, Roger and Michael (not my partner) – for your support and for being so fun to work with. There was always a joke to share or something to laugh about. And more importantly, we shared knowledge and learned heaps from each other. Thank you especially to Darice for driving me all the way home so many times in the evening! You are such wonderful company and I hope you are enjoying your time back in Singapore!

So, final exams…

O&G had 3 consecutive days of exams, how did they go?

(Note: Sorry, this might turn out to be a little long. I’m trying to put everything down to look back on in the future!)

Wednesday, May 07

A written multiple choice question (MCQ) exam. 60 questions, 30 gynae and 30 obstetric. I think there was a collective ‘what the hell happened feeling’ after finishing that exam. So much so that the cohort got together and reproduced most, if not all, questions from memory in order to further discuss them. Very dissimilar to the example of a previous exam they provided us, I think many of us felt this MCQ exam did not test fundamental knowledge required for an O&G rotation. In addition, there was unequal weighting of topics tested. For example, out of 30 obstetric questions, 3 of them (10%) asked about oxytocin – a drug used in active management of third stage labour.

Thursday, May 08

3 Obstetric OSCE stations. Each 8 minutes long and without perusal time. Talk about anxiety!

Station 1: An older lady who is obese, with hypertension on an ACE inhibitor and a previous history of 2 large babies has come in to see you (the GP) because she’s 8 weeks pregnant. The point of this station is to not only address the standard steps of care (confirm pregnancy, blood tests for type + antibodies, Hb, syphilis, Hep B/C, Rubella status, etc, dating scan, folate, diet…) but also to address her specific risk factors (age, obese, previous large babies, all risk factors for gestational diabetes and pre eclampsia, take her off her ACE inhibitor as it is a category D drug, etc).

Station 2: A lady in her late 3rd trimester has come into see you in the Antenatal Clinic with vaginal bleeding and a diffusely tender abdomen/uterus. Morphology scan at 20 weeks showed a fundal placenta – effectively ruling out placenta previa and leaving the likely diagnosis of placental abruption. Important points of this station was to identify the likely cause of bleeding, to admit her for further testing and monitoring of baby, inform theatre and anesthesia of potential need for emergency c-section, etc.

Station 3: A lady has active post partum hemorrhaging. Important points included resuscitation if necessary, discussion of possible causes (atony, retained tissue, trauma, bleeding disorder) and their management options, consenting for theatre and the need to inform the patient of the possibility she might need a hysterectomy.

I found the content of each station to be very fair and expected. However, what really disappointed me, as well as every other student I spoke with, is the lack of standardisation across examiners. For myself, the examiner at Station 1 did not let me speak freely, he only wanted me to specifically answer his questions – some of which did not even relate to a first antenatal visit. As a result, with such time constraints, I did not get a chance to say most of what is expected at such an appointment. When I proceeded to Station 2, every time I paused to think or see if the examiner had any questions, she would loudly say to me, “Don’t let me prompt you! What else do you want to say? Keep going!” She never actually prompted me with anything and I felt her constant berating very distracting and disruptive. Finally at Station 3, the examiner sat in complete silence and let me talk through anything I wanted until I stopped, only then did he ask further questions.

Overall, I think it went okay. I never know how I’ve performed at these types of exams because you are always your biggest critic. I can still think of things I should’ve said or things I could’ve left out.

Friday, May 09

3 Gynaecology OSCE stations. Each 8 minutes long and without perusal.

Station 1: Young lady is referred by GP to you in ED with few weeks history of iliac fossa pain. Ultimately supposed to rule out an ectopic pregnancy and come to the conclusion that likely ruptured ovarian cyst and/or ovarian torsion through discussion of investigations you would order and being given the results.

Station 2: Young woman presents to ED with symptoms of PID, confirmed with investigations. Incidentally, she has acute Hepatitis B. Needed to discuss her medical management including the need for hospital admission, contact tracing, contraception counselling, medical consult for the hepatitis.

Station 3: Vaginal bleeding in an older woman post hysterectomy on the ward. Management including resuscitation, discussion of consent, likely source of bleeding, etc.

Again, similar to the Obstetric cases, the cases presented to us were very fair, however, different standards of examiners across the board again. My examiners at Station 1 and 3 carried a discussion with me, letting me speak but also asking questions and pushing my knowledge, which was very good. My examiner at Station 2 was completely silent and cold, making me even more nervous. We were told multiple times that if we were struggling, not to worry, the examiners will provide prompts or attempt to put you back on track, but that certainly did not happen for me with Station 2.

I felt this was my hardest set of exams so far, mainly because of the quantity of OSCEs we had to perform and the uncertainty of whether I passed or not. I think I excelled at some stations and got a little stumped at a couple others. Marking is also very subjective, so all I can do now is cross my fingers and hope that everything went okay!

After this O&G rotation and as someone who is interested in General Practice/Family Medicine, I definitely think I will love the aspect of women’s health and antenatal care within that career pathway, yay!

And if you’re still here, a toast! To the end of second rotation! With Yoni and Christine 🙂

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Sydney: Hyde Park Inn

May 4-5, 2014

In conjunction with my last post, I stayed at Hyde Park Inn during my brief stay in Sydney to write my MCCEE.

I made the booking through Agoda and chose this place for a number of reasons: 

  1. Cheaper than other comparable 4-star hotels in the area, but looked very nice, bright, and clean
  2. Lots of positive reviews
  3. Free wifi in room, which is surprisingly not easy to come by – definitely needed this for my studying.
  4. Extremely close to the train station but more importantly, only a few minutes walk away from my test centre
  5. Continental breakfast included

I landed in Sydney around 10am, so I wasn’t expecting to be able to check in when I arrived at Hyde Park Inn. I was simply expecting to drop off my carry-on luggage and find a nearby cafe to study. It was a pleasant surprise that not only was I told my room was ready for me on early arrival, but that I had been given a complimentary upgrade from a Budget Standard Room to a Standard Studio… how lovely! 

From a “Small Compact Budget Standard Room with frosted windows which allow natural light into the room but with no view. This room offers one Queen Bed, with LCD TV and DVD player.” to a studio featuring “one queen and one single bed, kitchenette facilities with a microwave, en suite bathroom with shower facilities, air-conditioning and a window view overlooking Hyde Park.”

Was this a lucky sign for my exam? 😉

I loved that it was extremely bright and spacious. And so much room, too bad I was by myself! 

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It doesn’t look like it in this photo, but the bathroom had some of the best lighting I’ve come across in hotels… you know, the kind where you can actually use to apply makeup properly. Toiletries (except shower gel/shampoo) weren’t included but didn’t matter to me as I always bring my own.

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Hallway with large closet to the left and bathroom on the right. Iron and board were available in case you needed it.And a cute little kitchenette that contained everything you needed. Even a convection microwave oven.

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When I came into my room, there was already some uncovered sliced bread in the fridge, which made me think to myself, “This better not be the continental breakfast.” Fortunately, I was proven wrong when a staff member came by later to drop off breakfast, which consisted of sliced bread, Weet-Bix, cornflakes, fruit cups, milk, orange juice, butter and condiments for the toast. And because I was the only occupant, I got to eat for 2 or 3, who’s complaining?

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The one thing I did not appreciate, which I have seen others complain about in reviews, is the sliced bread. No joke, this was how it was left in the fridge for me. Some was wrapped up, some was not wrapped up at all, and some was very poorly wrapped. What the heck! Who wants dried out AND unsanitary toast? Also, the bread that was already sitting in the fridge? It wasn’t taken away and replaced with this bread… it was left for me. Not cool!

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However, the bread was literally my only complaint of the stay. The staff were extremely pleasant, the beds were super comfortable, everything was clean. Very quiet, which was really important to me in order to study and have a good rest before my exam. Checking out was not an issue and there was no problem with me leaving my luggage until later in the day. 

Would I stay again or recommend to my friends? Most definitely! 

MCCEE in Sydney

May 05, 2014

If you are a regular reader, you might remember that since the beginning of this year, I had been studying for the Medical Council of Canada Evaluating Exam, more commonly referred to as the MCCEE.

As a Canadian studying to be a doctor in Australia, writing the MCCEE is the first of a few steps if I ever want to complete a residency (training after graduating) back home.

I flew down from Brisbane to Sydney the day before to write my exam on May 5, 2014 from 9am to 1pm at ITIC PTY LTD LEVEL 3, 321 Pitt St. It is only a few minutes walk away from Museum train station and therefore easily accessible.

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Note: I’m going to be a little detailed with my experience, in case it can help anyone feel a little more comfortable going into their exam. 🙂

What did I bring?

I brought 2 pieces of ID, although they only looked at one, and my test confirmation email. Make sure that the name on your ID matches the name you registered with! I definitely wore a jacket in case it got cold and brought snacks and a bottled drink. There was water provided at my test centre. I also had other belongings with me like a purse, watch, study material, which was fine but must be locked up and access to them is not allowed during the duration of the test.

What was my experience like?

The test centre in Sydney, like all the others I assume, is very straight forward. You sign in and are given a key to store your belongings in a locker and taken to a separate testing area. You are not allowed to bring anything into the testing room except your ID and your key but you are allowed to have access to your locker during breaks. You will be seated at one of the cubicles where you have access to a computer, some paper and pencils to take note, and some headphones to drown out noise. The room I was in was small, approximately 5 cubicles, and got very warm – good thing there was a standing fan.

The computer is set up for you once you’re seated and you first have a 10 minute tutorial on how to navigate the exam (ie. moving through questions, how to highlight/strike out, how to mark questions for review, etc).

The exam is 4 hours long, which begins when you hit start and the first question is loaded. During these 4 hours, there are no scheduled breaks, however, you may take them whenever you want, for however long you want, it is up to you. The timer never stops, so your breaks are part of the allotted 4 hours. I have to say, 4 hours is plenty of time for this exam. After completing all the questions, I signed out for a break to go to the bathroom and to have a snack before going back in to review my questions, and still finished the exam with around half an hour to spare.

If you leave for breaks, you must sign in and out each time.

How was the actual exam?

The test consists of 180 questions total, however, only 150 of them are actually counted towards your score. The other 30 questions are used for quality control or even to test out newly developed questions. The questions revolve around the following 5 subjects: Child Health, Maternal Health, Adult Health, Mental Health, and Population Health and Ethics. Yes, I did find the distribution of questions equal amongst all topics. 

You don’t have to be concerned about knowing normal values or ranges. Any number given to you will be followed by the normal range in brackets, so you don’t even need to open a separate page. There were a few questions with images, which were displayed for you on the screen and the quality was completely fine to answer the question.

Unfortunately, I can’t give examples of questions but I did find all the questions to be fair, there were no impossible questions. The ones I struggled with, it was because I didn’t cover that topic enough during my studying, not because it was overly difficult.

The time passed quickly, although I never felt rushed and completed the questions at a steady pace. The relief and happiness after completing the exam is great, although I always find it hard to gauge how well I did on standardised exams. It takes about 2 months to receive your mark, so I have a long way to go!

What did I use to prepare for this exam?

I used mostly CanadaQBank questions and supplemented whatever question/topic not adequately explained with additional reading. I started ‘studying’ in January, however, with 2 busy rotations (Paediatrics and Obstetrics & Gynaecology), I simply did not have time to read additional textbooks. I found the CanadaQBank questions to be very representative of the MCCEE, both in terms of question style as well level of knowledge and difficulty – with even a few extremely similar questions on the actual exam.

CanadaQBank had a total of 3868 questions, of which I did approximately 80%. I didn’t have enough time to prepare for this exam as well as I would have wanted, but it is definitely possible to complete all questions multiple times if you have a good study schedule.

I also tried some USMLEWorld Step 2CK questions but stopped because the style was too different than the MCCEE. You will not have such long stems and style of question on the MCCEE.

Fees?

The cost of the exam is $1695 USD along with the expenses of flying down to Sydney, food and accommodation. It’s not a cheap exam and I suggest to be fully committed to passing it if you are going to write it. I had initially scheduled to write my MCCEE on February 28, 2014 with Michael in Melbourne. However, at the last minute I rescheduled it to May 5th ($50 USD fee) because I felt underprepared and uncomfortable with the possible notion of failing. Looking back now, with an extra 2 months, I did not get much additional studying done and probably would’ve performed similarly if I had written it earlier.

What next?

The next step is to complete the NAC OSCE… which I am not planning to complete anytime this year, so I will save that for a future post. 😉

Phew, long post! Thanks for reading if you are still here and of course, feel free to ask any questions! All the best if you are studying for your MCCEE!

DHAL: May 19, 2014

So this will be my first, of hopefully many, Daily Highlights & Lowlights (DHAL) blog posts.

In case you didn’t see in an earlier post, I’ve decided to start this series because I was finding it difficult not only to keep up with blogging but also to find interesting things to write about during busy and full-on rotations. I thought this would be a good way to remember the happy moments, as well as the more difficult ones of each day. Hopefully when I look back at these posts, I will be able to see how I’ve grown from the positive and negative experiences on a daily basis.

Highlights:

  • The excitement of starting a new rotation! I’m currently doing my first of 4 weeks in the Emergency Department (ED) at a big tertiary hospital. The best part is, as opposed to the last hospital I was working at (1.5hrs away each direction), this hospital is only 5-10 minutes away by bus!
  • Meeting new people. Not only did I have a chance to meet some lovely classmates, the doctors and nurses I’ve met in ED were also extremely pleasant. Some are very keen to teach and for that I am very grateful.
  • I did a few cannulations, and I’m happy to say… all of mine were successful on first attempt! I’m always a little nervous (especially in a new environment and on the first day) and never want the patient to have be pricked multiple times, so yay!

  • The patients I met and the things I learned from them:
  1. We had a few patients come in with chest pain, some very typical of cardiac pain but there was a lady with such unspecific pain and symptoms that we had to quickly rule out a life threatening aortic dissection.
  2. Met a man who was also having chest pain and syncope on a background of kidney failure needing dialysis 3 times a week. He had the most amazing arteriovenous (AV) fistula that anyone had ever seen – huge with a proximal pulse and a distal buzz/hum.
  3. There was a trauma alert for a man who fell off his motorbike going 30-40km/hr having to suddenly brake and swerve to avoid a collision. Luckily he was completely fine except for some abrasions and a broken L clavicle.
  4. A man who had a pneumothorax two weeks ago and fed up with his pain and shortness of breath. His CXRs were impressive, with most likely over 80% of his left lung collapsed. He initially wanted to manage it expectantly because he didn’t want an ICC. The doctors used a central venous line through his anterior chest and sucked out over 2L of air with instant relief.
  • Talking to Michael. Although only via text, I was happy he didn’t run into any issues during his flight back to Canada. Poor guy was exhausted but there were no issues with his flights and the additional 4-5 hours of driving went well! He shared some gorgeous views of his drive and look, mountain view just outside the place he’s staying at.

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Lowlights:

  • Getting to orientation at 9am to be told that my first ED shift would be from 1-11pm in the Resuscitation/Trauma area. I was so nervous! An evening shift on my first day where I’ll be working with the sickest people that come through the emergency.
  • The constant feeling of not knowing enough. There is always more to learn and things to review!
  • The feeling of exhaustion when I finally got home around 11:30pm. My legs and feet were incredibly sore from standing the better part of a 10 hour shift. Not to mention it was quite busy so I didn’t even take a break! I also need to make sure I stay hydrated as a headache started creeping on in the last hours of my shift.
  • Coming home to an empty house and not seeing Michael. I’m so used to his company so it is awfully lonely when you don’t have anyone to talk to!

April moments

During my Obstetrics & Gynaecology rotation, I was often leaving the house before 6am in order to be at the hospital in time for 8am. It was a drag, but some things made it worth it. The fact that I got a bit more exercise, since I was walking approximately 7km everyday to and from the train stations. Rediscovering all my favourite songs on my iPod. Since most of my travel is with Michael, I always preferred chatting in his company rather than listening to music. Walking by myself was actually quite a nice and relaxing change of scenery, something I used to know so well but had become unfamiliar to in the last few years.

And little moments with nature you experience. Like this possum carrying her young one across an electric wire:

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And beautiful skies like these over my head

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On April 11, we attended The Dashounds’ Kids Again EP launch at The Hideaway. The Dashounds consist of our two friends James Fielding and Pete Dixon, as well as Bas Pelly and Steve Ceccato.

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A Brisbane based, indie/pop/acoustic band, here is a quick blurb from their Facebook page:

The Dashounds have supported Josh Pyke,The Resin Dogs, and shared Festival stages with Regurgitator, Boy and Bear and many more. They played at the Caxton Seafood Fest and the Red Deer Music Fest in 2010, ’11 and ’12 to packed audiences of happy tail waggin’, raindropping fans. The ‘Hounds have recorded two EPs (available on iTunes). They are best known for their vibrant multi-layered vocal harmonies, dynamic acoustic pop anthems, and quirky lyrics about girls, dogs and their beloved home town of Brisbane.

A really fun and great night with amazing performances by the guys.

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CLICK HERE to visit triple j Unearthed and check out some of their tracks, even download! You are missing out though, because the recordings simply cannot capture the sound and energy of their live performances!

Bought a hardcopy, can you see the outfit similarities? 😉

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Despite a busy rotation, we did get out once in a while! About to head out for some yummy dim sum at New Shanghai with Yoni and Xuan in this photo.

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This was also the night we discovered a dish called “Deep fried calamari coated with salted egg yolk” Deliciously crunchy, rich and salty dish that was extremely well received by all of us!

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Girls day out with Christine, Fiona, Kristen and the cute Abigail on April 13th!

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Started with a lovely breakfast at Samson and Sophie Cafe in Teneriffe, followed by a walk along the river that ended with a drizzle and left us at the Old Museum enjoying tea and each other’s company for a little while longer… oh no! 😉

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As babies often command, and being as cute as Abbey is, she was definitely the centre of attention!

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Not often are the 4 of us in the same place at the same time, so it was lovely seeing them all and catching up!

And my sad attempt at photographing the Blood Moon night of April 15th. 😛

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My pathetically long blog absence

Dear friends,

Where have I been? Here and there. Doing this, doing that. I’ve been terrible at including you, I know. I’m sorry!

Today has been a very difficult and emotional day for me. Michael, my fiance, is currently flying back to Canada where he will be completing his next two rotations (3rd – Critical Care and 4th – Medical Specialties) while I remain in Brisbane. It will be an exciting and scary journey for him rotating through a number of different hospitals, but I have no doubt he will fit in and excel. Fortunately, I will also have the opportunity to complete Rotation 4 (starting in two months) in Canada. During the last 4 weeks of that rotation, we will be only 1.5 hours drive apart so we’ll finally be able to see each other! I already feel so alone! Never in the years we’ve been together have we been apart or tested by a long distance relationship. I’m sure these next few months will not be easy but thank goodness for texting and video calling. I miss him so much already.

I have a number of topics to catch up and share with you on this blog, including:

  • Some happy moments with friends back in April
  • The MCCEE exam that I finally wrote on May 5th
  • What food have I been making?
  • My Obstetrics & Gynaecology rotation that ended May 9th, including how the final exams went!
  • Our amazing one week vacation in Bali (May 10 to May 17) which was also our first experience with Club MĂ©diterranĂ©e, commonly known as Club Med
  • The wedding of our 2 wonderful friends James & Kim on May 17th
  • My upcoming 3rd rotation in Critical Care

In addition, as I have found it very difficult to not only keep up with blogging but also find interesting things to write about during busy and full-on rotations, I have decided to start a new daily blog series project. Starting tomorrow, the first day of my 3rd rotation (Critical Care), I will be doing a Daily Highlights and Lowlights (DHAL) post. This idea was inspired by April & Justin whose daily vlogs I enjoy enjoy watching on YouTube. At the end of each of their videos, they share the highlights of their day. I thought this would be a good way to remember the happy moments, as well as the more difficult ones of each day. Hopefully when I look back at these posts, I will be able to see how I’ve grown from the positive and negative experiences on a daily basis.

Thank you for sticking around with me, I hope you enjoy the blog posts to come!

Obstetrics & Gynaecology: The biggest privilege

Yesterday, I took part in, what I believe, is one the biggest privileges as a medical student: Delivering a baby.

One of the most intimate moments for a woman and her family, where inhibitions are lost and emotions quickly bubble to the surface – pain, excitement, fear and joy.

Thank you to all families who allow us medical students not only observe but even deliver your child as part of our training experience, especially to the two women whose babies I delivered yesterday. New life is such a miracle and the experience of being the person who catches a baby as he/she is born and hand him/her to mum is one that cannot be easily written into words.

I also cannot forget to mention the lovely midwives who I have been working alongside with. Without their expertise, patience, and teaching, I would not have been able to comfortably embrace such a special experience, thank you!

Obstetrics & Gynaecology: End of Week 4

Hello friends!

What an exciting, long and busy 4 weeks! Can’t believe so much time has past since my last joyful post! Thank you again to family and friends who have shared their congratulations with us! We certainly appreciate the love, friendship, and support very much.

I am completing this rotation at a different and smaller hospital outside the city, and it has taken a toll on me! Waking up at 5am in order to be at the hospital for 8am and not usually making it home until 6:30pm. As you can guess, there’s quite a bit of transportation time involved. With that being said, at least I have 3 hours of dedicated study time during my trips on the train? 😛

There are only 4 other O&G students at this small hospital, 3 of whom I already know, which is great. We have lots of opportunity for hands on learning and the teaching has been quite good as well. Our schedule revolves around clinics every day, as well as time in the operating theatre which isn’t so bad. However, all of us would really appreciate having dedicated studying time as well!

I will be rostered on Birth Suite for the entirety of this coming week. As a requirement of our O&G rotation, we must ‘catch’ 4 babies. This means following and caring for mothers while they’re in labour until delivering their child with your own hands. Unfortunately, the other 4 students have not been able to get all 4 of their catches during their Birth Suite week, hopefully I have some more luck!

So what do I have the privilege of seeing on my O&G rotation?

A lot of antenatal care (regular follow up and high risk pregancies), post-menopausal bleeding, heavy, irregular or painful periods, abnormal pap smears, contraception, urinary incontinence and more. In theatre, we often have the chance to see minor procedures like hysteroscopy with dilation and curettage, endometrial ablation and tubal ligation to more extensive surgeries like hysterectomies (removal of a uterus) and Caesarean sections.

Only 4 more weeks to go until the end of this rotation! How time flies!

Melbourne: Shrine of Remembrance, Botanic Gardens, and more

Sunday, March 2, 2014

Today was our last day in Melbourne, with our flight back to Brisbane at 10pm. After checking out of our serviced apartment, Dorcas, and temporarily storing  our luggage with them, we walked across the street to visit the Shrine of Remembrance.

“Built as a memorial to the men and women of Victoria who servd in World War I and is now a memorial to all Australians who have served in war. It is a site of annual observances of ANZAC Day and Remembrance Day and is one of the largest war memorials in Australia.”

An impressive structure, even from afar

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View of the front

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View from the front

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Two visitors being given a tour. At their feet is the Stone of Remembrance, engraved with “Greater love hath no man.”

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Every year at 11am on Remembrance Day (Nov 11), sunlight shining through the aperture lights up the word “love” on the Stone of Remembrance below.

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You can actually go upstairs and onto the balcony

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View from above the front entrance, looking into the CBD

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The Cenotaph and Eternal Flame to the right of the front entrance

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View from the back of the balcony

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Walking around the side towards entrance to the Royal Botanic Gardens

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Higher up view of the same side

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We then crossed the street to visit the Royal Botanic Gardens, a lovely space to enjoy all sorts of activity.

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While we sat in the park to have brunch, we saw an Asian church group gathering singing songs and playing games, a family with 2 children playing soccer, and 2 girlfriends doing yoga.

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A real life ugly duckling? First time I’ve seen a black swan!

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After a short walk through the gardens, we walked towards the city, stopping to properly visit the National Gallery of Victoria – International. Although we didn’t take any photos, we were quite impressed at the collection, and the fact that it was completely free for visitors – highly recommend!

The Arts Centre is right next door. Perhaps we will see a show next time we are in Melbourne.

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By now, we were starting to think about lunch and passed by Federation Square where they were having Pancake Day! Not wanting to spoil our appetites for lunch, we didn’t participate in the festivities which looked like fun.

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We had already decided to search for one of our favourite dishes, Japanese ramen, for lunch. After finding Little Ramen Bar on Urbanspoon with an 87% rating, we walked in anticipation all the way there only to find out they are closed on Sundays! Our bad for not paying more attention. Where did we end up having lunch? Find out on the next blog! 😉

Melbourne: Quest on Dorcas

Mike and I were in Melbourne for the MCCEE on Friday, February 28th. Poor Mike got gastroenteritis the night before his exam and wrote it in horrible discomfort. As for myself, the MCCEE deserves its own blog post, which I will be writing at a later date.

During our time in Melbourne (Feb 26 – March 02), we stayed at Quest on Dorcas, serviced apartments right off St Kilda Rd by the Shrine of Remembrance. And we highly recommend!

Well equipped, lovely, and clean apartments. Quiet, comfortable, and close to the tram station with everything we needed nearby. Staff were hospitable and we were actually upgraded on arrival. We had absolutely no complaints regarding our stay, however, it would be nice to have free wifi and/or newer TVs so we could load watch own entertainment via USB. Thank you Dorcas for a great stay! We will definitely choose you again if ever in Melbourne!

Here are a few photos of our apartment:

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Stayed in the first couple of nights in order to focus on studying. Right after we checked in, we walked to the nearest Coles in order to stock up on groceries and the apartment had everything we needed to make our meals. Our only suggestion would be to have better knives please, it’s hard to cut veggies and fruit with serrated knives!

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The view of Eureka Skydeck 88 from our apartment

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And the lovely night view of CBD

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We didn’t actually go out to see Melbourne until the weekend, those posts coming up! 😀 Thank you for reading and definitely keep Dorcas in mind if you are looking for a place to stay. It is also extremely walkable to the CBD and all attractions 🙂

Paediatric Medicine: End of Rotation 1

Hi friends 🙂

Today marked my last day of Rotation 1 – Paediatric Medicine, which I completed at a large tertiary hospital.

8 weeks on a variety of teams, soaking in as much as possible, in as little time as possible.

  • 2 weeks in General Paediatrics
  • 1.5 weeks in Emergency Department
  • 0.5 weeks in Neonatal Intensive Care Unit (NICU)
  • 1 week in General Surgery
  • 1 week in Gastroenterology
  • 1 week in Oncology
  • 1 week in Respirology

I definitely enjoyed some placements more than others, for a variety of reasons including: personal interest, consultants and senior staff more interested in teaching, and the learning opportunities provided.

For this rotation, we had a number of assessments, including 3 mini clinical examinations (mini-CEX, each worth 10%): neonatal (well-baby check), short case, and long case.

My well-baby check was performed an adorable newly born girl and her lovely parents. She was a little hungry and crying during my examination but was perfectly healthy.

My short case was a respiratory exam on a 1 year old girl who presented with noisy breathing. She was recovering from bronchiolitis and by chance also had a number of neurological findings with associated developmental delays.

And lastly, my long case was a young adolescent girl who presented with fevers on a background of complex mastoiditis leading to the severe complications of intracranial abscesses and venous sinus thrombosis. Incidentally, she had many features consistent with Cushing’s which led to additional discussion points.

The feedback I received from all 3 of my assessments were positive, so hopefully my grades will reflect that!

And today was the big day. A multiple choice exam of 75 questions worth 50% and 2 OSCE stations, each worth 10%.

The written exam was overall fair and very representative of our teachings this rotation.

The clinical exams each had 2 minutes perusal followed by 8 minutes of discussion:

  • Case #1: A 5 week old girl who came in with signs of sepsis.
  • Case #2: A 5 year old girl with acute exacerbation of asthma.

For each case, we had to discuss what additional information we would like on history and examination, what our differential diagnoses were, what investigations we wanted to perform, and how we’d like to manage the patient.

Those 10 minutes go by in the blink of an eye, and I always walk away thinking, “Should’ve said that, could’ve done that, forgot to ask about this, didn’t mention that.”

Only time will tell how I did this rotation! Hopefully hard work paid off.

In the meantime… I would love to catch up on my sleep. However, before I do that, I need to catch up on my blogging! Thanks for reading! 🙂

ValenSports Day 2014

February 14, 2014

Ah yes, the highly anticipated yearly event for many UQ medical students – Sports Day!

What is it? A whole day of sanctioned drinking and fun, dressed in scrubs. Here’s what the breakdown of the day looks like:

08:00 – 4th years have breakfast at the Mayne Medical School
09:45 – 4th years move on to Birdees to join the 3rd years
10:45 – 3rd & 4th years move on to Transcontinental Hotel to join 2nd years
11:30 – 2nd, 3rd & 4th years move on to Fox Hotel to join first years
12:00 – All move on to Dutton Park for General Fun with games, slip’n slides, jelly pools, bouncy castles, BBQ, etc.
17:00 – Leave from Dutton Park to after party venue

As you can see, it is literally a whole day filled with lots of drinking for all parties involved.

The #1 rule of Sports Day is: Only fourth years are allowed to wear pink scrubs, or pink anything. Anybody in the years below caught trying to wear pink will be severely punished 😉 Other than that, it’s all about having fun and enjoying the day!

Despite it being a yearly tradition, I’m sure there are many people in Brisbane who get quite confused seeing loads of people dressed in scrubs flood the streets, venues and public transportation… while intoxicated… during the day. I think this year may have been even more confusing for the general public as it was Valentine’s Day and many were dressed in pink. We even had a mention on Reddit 😛

My favourite aspect of Sports Day is champagne breakfast with PBL 25 and friends before beginning the day, pretty much a tradition now! In case you don’t know, PBL 25 was our allocated tutorial group back in first year.

This year, we met up around 6:30am at Fi’s mum’s – thank you again for having us 😀

Unfortunately, Michael didn’t join the festivities. The morning is when he studies best so he took advantage of that to study for the MCCEE. And I left after the fourth year breakfast in order to study too! Home by 10:30am, not too bad!

Some photos, enjoy!

Note: If you are interested in more photos and seeing what the entire day is like, a colleague did a great job capturing those moments. Hopefully you can view his album HERE

Breakfast

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So much food!

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PBL 25 girls + Little One!

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Group photo!

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PBL 25!

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The girls again

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Mr Fielding, the creative one 😛

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Driving over to Mayne Medical School for breakfast and to meet up with all the other 4th years

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See of pink

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Welcome speech from Professor John Pearn, our beloved UQMS Patron and Honorary Life-Member of the Society

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Photos with friends!

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So much pink! Had a good morning, lovely to see faces I haven’t seen in a while but definitely couldn’t be as carefree as everyone else with the MCCEE looming over me. Also needed to get studying done so that we could have the evening off for Valentine’s Day! But that’s for another post…

 

 

Year 4 Medical School: What’s going on!?

Hello friends!

It seems I’ve gotten into the habit of not regularly blogging – arg! I’ll try really hard to fix that, I promise. 🙂

As some of you may know, I’m now in my 2nd week of 4th (and final) year of medical school! My first rotation is Paediatric Medicine, which I’m absolutely loving. I feel quite lucky that all the doctors and staff we have come across have been kind and more than willing to share their time and teach us. More importantly, parents and their children have been very receptive of students, which makes all the difference in the world, because that’s the only way we learn – on real patients!

Also, babies are so freaking adorable, I can’t get over it. 

With that being said, I’ve also been quite busy and stressed out. 

During the day, I’m in the hospital on my rotation. When I get home, I have to put all my focus into studying for the Medical Council of Canada Evaluating Examination (MCCEE), which Mike and I will be writing on February 28th in Melbourne. That’s less than 6 weeks away! 😩 

The MCCEE is the first big step that we Canadians Studying Abroad (CSA) or International Medical Graduates (IMG) need to take in order to be eligible to apply for a training/residency program in Canada once we graduate. It is a daunting 180 multiple choice question exam that covers 5 broad topics: Child Health, Maternal Health, Adult Health, Mental Health, and Population Health and Ethics. 

Needless to say, we are freaking out. There’s so much to know, in so little time. The most challenging part is studying for Maternal Health when we won’t have actually started, let alone complete, our Obstetrics and Gynaecology rotation yet. 

The good news is, our leave from Feb 26-28 has been approved! That means we will be flying down to Melbourne on the 26th and have 2 dedicated days to study before our exam on the 28th. And then we will have a weekend to explore and see Melbourne, yay! 

Until then, study! 🙂 

Post-Medicine rotation gathering!

November 15, 2013

(I know, I’m now writing out of order too, sorry! :P)

In celebration of our time together throughout our Medicine rotation AND the fact that we finished our last exams of third year – we had to celebrate… with food, of course!

Very happy that most of us were able to meet for dinner Friday evening, hurray!

After some discussion, we decided on New Shanghai as they have many yummy and generous sized dishes to share. In particular, dumplings. Need I say more?

Credit to Sarah for the photos!

The ones who couldn’t make it: Clarence, Yung Howe, Tomas, Joseph, Mustak, Manisha, and Sunny

Adi, Kee Ping, Sarah & Daniel

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Me, Mike, Xuan & Christine

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Sarah & Daniel

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Mike & Xuan

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Daniel & I

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Love this picture 🙂

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For dessert, it didn’t take much convincing for everyone to join for some frozen yoghurt, yum!

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Thanks for the good times guys, have a great holiday!

The end of third year medical school!

Yes yes, that day has finally come!

Yesterday marked the end of my third year in medical school, woo hoo! I had two clinical exams for my final rotation (Medicine), both of which I left with mixed feelings…

The first exam was a long case – 1 hour with a patient during which we must get a full history and do a full examination. Followed by 20 minutes with two examiners where we present our case and get grilled with lots of questions. My patient’s presenting complaint was post-fall following possible syncope, with digoxin toxicity on a background of atrial fibrillation as well as chronic kidney disease, hypertension, and reflux disease.

The second exam was a short case – a focused examination completed within 8-10 minutes, also followed by a brief summary/presentation to the examiners and being questioned. Our short case was a cardiovascular examination on a patient who presented with shortness of breath. We later mostly agreed on the significant findings of murmurs and other signs of biventricular heart failure.

Hopefully I passed! But it’s so easy to look back and think, “I could’ve said this” or “I should’ve asked that.” Only time will tell now, our marks should be released in a few weeks!

Finished up packing this morning. Just need to pick up a couple last things but so ready to hop on a plane back home! Hopefully Mike and I can hit the beach tomorrow for some last minute relaxation (and tanning ;)) before heading back to Canada early Sunday morning.

Will be staying over in Vancouver for a couple of days to visit my sister. I’ve never been before so pretty excited! Here’s our flight itinerary:

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3 weeks since I last posted!

Unbelievable how fast this rotation has gone by… tomorrow is already my last day in hospital… of the year. Then final exams next week!

I haven’t blogged in over three weeks, ashamed! No excuses! Although getting home late most days leaves me completely exhausted, especially after dinner when I still have to study 😩 That, and I have not done anything interesting during this rotation! Mostly focused on school, I haven’t even been taking photos regularly! Oopsies.

I’m very excited to be approaching the end of third year, which has been fantastic. I love being in the hospital, being part of a team, and the opportunity for hands on learning. Definitely excited to be finishing up this year, but a little apprehensive about next year as well, ah!

Here are a few updates:

  • So fortunate to have been a part of such an awesome medical team for this rotation. We are having a farewell lunch tomorrow… I’ll definitely be a little sad but it will be nice to see their faces next year as well 🙂
  • Final exams next Wednesday morning! It will consist of a long case and a short case. For the long case, we get 1 hour with a patient and during that hour, we must get a full history and do a full examination. This is followed by 20 minutes with two examiners where we present our case and get grilled. The short case will be a focused examination completed within 8-10 minutes, also followed by a brief summary/presentation to the examiners and being questioned. Sounds nerve wracking? It is!
  • Because real patients are used for our exams, we are banned from the hospital as of Friday. That way, newly admitted patients are kept secret 😉 And so, I’ve decided to go to the beach this weekend. Relax and do some reading under the sun… lots of reading to get through in preparation for my exams next week!
  • Will be going to my first baby shower! Mum-to-be is my lovely friend Kristen, who makes pregnancy look absolutely beautiful!
  • Then Mike and I are flying home on Sunday, November 17th at 7:45 am! We’ll be heading to the airport quite early, will we be up all night doing last minute packing? Mike will for sure. I’ll be doing my packing while procrastinating studying for exams.
  • We’ll be arriving in Vancouver on November 17th at 7:25 am and will spend a couple of days visiting my sister (studying OT at UBC) before going back to Ottawa, arriving at 11:40 pm on November 19th!
  • Yay, I’ll be home for my grandpa’s 80th birthday!
  • After many weeks of snail mail, I have finally completed my registration to write the Medical Council of Canada Evaluating Examination (MCCEE)! This will be the first of 4 Canadian exams I will have to complete should I wish to train in Canada. My exam will be on February 28th in Melbourne!
  • I have a lot of studying to do… for the rest of my life.
  • But yay, home soon! And for Christmas!

Medicine: Almost there!

Hello friends,

It feels like forever since I have blogged! It’s not that I don’t find my life exciting at the moment but that I always feel short for time 🙂

This is my second (of 8) week on my Medicine Rotation… The last rotation of third year, woo hoo! It has been great so far and a confirmation of why I love medicine. My partner this rotation is Adi and I think we both feeI quite lucky to be on our team. We have 2 consultants who are both great teachers, 2 interns who are super cool and appreciate our efforts in learning and helping out, and a (Canadian) registrar who seems to know everything… How could I complain?

Don’t let my positivity fool you though, medicine is a challenge. Especially after 2 months of surgery and 2 months of mental health… I feel like I have to relearn everything!

Medicine can be exhausting though, particular with many tutorials through out the week. Once we get home and have dinner, we always feel like doing nothing but going to bed early. But we can’t! Because there’s always so much to read up on and review!

Oh well, that is a part of life! At least we’re enjoying what we’re studying right?

I’m so glad it’s the long weekend, thanks Australian Labour Day! Now I have time to catch up on my studying.

However, I can’t get one of our patients off my mind…

An elderly gentleman who has severely deteriorated since being admitted a few days ago, and we haven’t been able to ascertain why. This lovely man with a particular love for Coke is now on palliative care and surrounded by his loving family. He’s not expected to live for much longer and I couldn’t help my teariness when we spoke to the family. I also couldn’t help it but the situation really made me think of my dad… 😩

No matter how prepared and knowledgeable you are… Death is never easy to deal with. In this case, especially because that person has made such an impression on me in so little time… 😩

Mental Health: The End!

Yesterday marked the end of our fourth rotation, Mental Health – yay!

The past 8 weeks seemed to have gone by in the blink of an eye. We saw patients when they were admitted, learned their stories, followed their progress and said good bye when they left… a humbling and worthwhile learning opportunity.

Despite being laughed at by our registrar many times at our pathetic initial attempts of presenting a Mental Status Examination and formulation… in the end he said we did well and our evaluation backed that up.

Many thanks to our Registrar and the Consultants who took us under their wing and taught us throughout this past rotation. They are so knowledgeable and have so much experience to impart, couldn’t have done as well as we did without their guidance! And of course, to the wonderful staff at our hospital 🙂

On Thursday, we had our clinical exam where we were provided a vignette (clinical situation on paper) and 20 minutes perusal time. Then we had 20 minutes to present a summary, formulation, differential diagnoses and rationale, additional information needed and management plan to 2 consultants/examiners. I was SO nervous. But as soon as I sat down and started reading, I immediately calmed down – a case of an elderly patient in the hospital who developed delirium. Something I was familiar with and had prepared for, yes! I think that exam went well, but only time will tell what my 2 examiners thought!

Then we had our written exam yesterday, 50 multiple choice questions. As always, there were a handful of questions that left us thinking, “What was… what?” But in general, we left with a sense of security rather than panicked with the thought of, “Oh my god, I might’ve failed that,” racing through our minds.

So now, one week vacation!

Haven’t done anything… yet 😉 Hopefully it will be relaxing and full of nature! We have some plans but I’ll update as it happens!

Mental Health: What’s the deal?

Wow,

I am terribly behind with my regular blogging! 😩 There’s no excuse, but it’s been busy and blogging about our recent vacation took a lot longer than usual.

So what’s the deal with school now?

Well, I’m 5 weeks into my Mental Health rotation, and yes, I’m quite enjoying it! By random luck (or is it bad luck? Haha), both Mike and I got placed as the only 2 students at a private mental health hospital in Brisbane.

The experience so far has been very enlightening. We found it initially daunting and awkward learning to take a psychiatric history from patients and formulating our thoughts. The feeling is quite similar to being in first year again, learning how to take a medical history and talk to patients. Fortunately, we’ve gained a lot more confidence in the last few weeks. Taking a medical history is like second nature to us now, hopefully taking a psychiatric history will, in time, feel the same.

We are humbled and grateful every time a patient agrees to talk to us or allows us to sit in during a consultation. If you think about it, these people are sharing with us, complete (not yet qualified) strangers, the most personal aspects of their lives. Some people have been victims of sexual and/or physical abuse, others have gone through great losses, some struggle with their spouses having affairs, while others have thoughts of self harm and have even tried to kill themselves. Every single patient we’ve met has taught us something, in some way, that we could never learn from a textbook.

Every patient we’ve met has a different story and is fighting a different battle. One of the first and biggest challenges for us has been, “How do we talk to these patients? How do we approach sensitive topics in a way that will not be upsetting?” We quickly learned that despite all the differences, these patients are all still the same in one way: Like you and I, they are people too.

Talking to patients with mental illness or a difficult life/past can be hard. But it’s not necessary to over-think how to talk to them. As long as you are patient, empathic and a listener, most people will be more than happy to talk to you and share their stories with you.

We also get scheduled teaching time with 3-4 consultants every week, which has been great. They have all been great teachers and we’ve learned so much already! Not just in terms of knowledge aspect, but also plenty of real life stories and experiences – something you can never learn from reading a book.

Have I mentioned we have a great Registrar? Yes, thank goodness! Most of our day is spent with him and the patients. He’s pretty awesome with them and definitely a good role model to try and emulate. As one of our profs said, “Shamelessly steal!” Adapt the styles, sayings and techniques from your seniors and colleagues that can make you a better doctor!

The most scary aspect of Mental Health at this moment? The fact that we are approaching the end of Week 5… only 2 more weeks until final exams. Absolutely crazy. It’s insane how quickly time has gone by!

Surgery: You’re full Vietnamese?

During a chat with one of our patients, it was mentioned that both my parents are from Vietnam.

“Both your parents are Vietnamese?!” This pleasant gentleman asked.

Yep!

“So you were born in Canada?”

Yes I was!

“I wouldn’t have guessed you were Vietnamese!”

I’ve heard this many times before, so I responded with, “A lot of people have said I look Chinese or Japanese.”

He said, “Well… I thought you were a half case…”

A what?

“You know, a mixed race. Because you speak English perfectly!”

Why yes, that’s because I was born and raised in Canada!

Surgery: The uterus is pretty cute

Last week I had a chance to observe a 2-in-1 surgery.

There was an elderly lady with colorectal cancer who needed to have a high anterior resection. In this surgery, the sigmoid colon and part of the descending colon are removed. The remaining descending colon is then anastomosed (re-attached) to the rectum.

This woman also had a large lesion in her uterus and would need to have a hysterectomy (removal of her uterus) as well. It was decided that both surgeries would be done laparoscopically (minimally invasive surgery done through a number of small incisions, also known as keyhole surgery) and at the same time.

After the colorectal team finished mobilizing (freeing) the colon, the gynaecology team took over and removed her uterus, fallopian tubes and ovaries. The colorectal team then came back and finished the surgery, taking out the part of her colon with cancer and reattaching the remaining parts.

The other medical student observing the surgery with me told me to expect the uterus to be really cute. So tiny with its little fallopian tubes and ovaries. I have to say, she was right! How amazing that such a tiny thing can carry babies for 9 months. This woman had had 6 children!

I asked permission to take this picture. You can see the uterus with the fallopian tubes and ovaries (white oval structures). And if you look closely, you can even see some cysts, with clear fluid in them.

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