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! 😉

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!

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 🙂

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. 🙂

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!

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!

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!

Post-Surgery… Vacation!

Surgery is officially over, woo hoo!

Our final written exam (worth 70%) was yesterday… 2.5 hours of looong testing-of-knowledge. The exam was certainly challenging, as many of my friends have agreed, but now we just have to sit and wait for our results!

More importantly – on to a one week vacation!

Mike and I were able to score really cheap plane tickets, so we are going overseas for the holiday!

Today, we are going down to Gold Coast.

Tomorrow morning, we are flying out to… Singapore!

Yep, again.

Our super basic itinerary:

  • July 12 – Gold Coast
  • July 13 – Singapore
  • July 14-17 – Bangkok
  • July 17-20 – Singapore

All our flights added up to less than $500, which we thought was a steal! We have already booked all our accommodation but haven’t really finalized our plans of where we want to go and what we want to do yet.

Like usual, I will try to blog whenever I can! If not, there will be tons of photos and posts after we come back 🙂

Have a great weekend everyone! And for those on a holiday like me, have a lovely vacation!

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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My Ways of Being a Better Medical Student

I believe trying to observe the following makes me a better student doctor.

Here are My Ways of Being a Better Medical Student:

(Didn’t realize this post would be so long, so I added some pictures from the internet. Photos are linked to their sources!)

Always introduce yourself – to patients and to other staff members. You’ll be meeting people all the time, under a variety of circumstances, at all times of the day. It is only polite and respectful to let everyone know who you are – even just in case you’re not even wanted! It has happened to me a number of times, sometimes patients just want medical students to sit out from consults. It can definitely be awkward, even scary, to find the opportunity to introduce yourself but you just have to man up, find an opening, and do it! Trust me, I know first hand how awkward it feels, especially when it’s one of your registrars or consultants you’re finally seeing for the first time (maybe during rounds) but completely ignoring you. But, more often than not after introducing myself, people will treat me differently – I’m no longer invisible and even addressed by name, who would’ve thought! 😉

Say hello when passing others, and smile. It takes no effort from you and can brighten someone’s day. Win win.

Don’t gossip. And if you must, do it outside the professional environment and out of earshot from everyone else. It makes you look unprofessional and you never know who might be listening. The medical world is small and word can travel fast – don’t sink yourself! You never know who you will cross paths with again and that one person you bad-mouthed could end up being your preceptor, your examiner, etc. If there’s someone I particularly don’t like, I always try to find someone else more constructive to my learning and morale and spend my time with them instead.

Never be afraid to ask questions. It shows you are listening, processing information and are willing to learn. Some people are great teachers and love the opportunity to share their knowledge – they’re just waiting for you to take initiative. Of course, with that being said, there’s always a proper time and place for questions. If someone is having a heart attack, no one wants to hear, “Could you show me how to read the ECG?” And you should really have enough common sense not to ask “stupid” questions that will only make you look bad. If you’re a 3rd year medical student asking, “What’s aortic stenosis again?” you are going to be in big trouble and look ridiculous!

Never be afraid to say “I don’t know.” I have no problems saying, “I’m sorry I don’t know, could you show/tell me?” when I really don’t have a clue how to answer a question I’ve been asked. If I can give an educated guess, I do, but otherwise, there is also nothing wrong with, “I’m sorry, I’ve forgotten, could you remind me?” Sure it’s embarrassing for you, but you will learn on the spot and/or never forget that information again. I’ve lost count how many times I’ve heard, “That’s okay, this way you learn and won’t forget again!” For example, the other week, my surg team was commenting on the long half life of the drug Rutiximab (21 days). The registrar then says, “At least it’s not as bad as Amiodorone! Sandra, what’s the half life of Amiodorone?” I laughed (as if I would know this) and replied, “I know it’s more than 21 days!” Now I will never forget Amiodorone has an extremely long and varied half life of 25-100 days. However, not knowing the answer should happen much less than 50% of the time you are asked questions, otherwise, you don’t know enough and you should go study!

Learn as much as you can on the spot. At this point in our lives, we’re not going to have our hands held and be told what to study. Pay attention on the wards and learn as much as you can – that’s often the useful stuff that you can’t learn as easily from textbooks. Bring paper or a notebook and jot down all the things you learn throughout the day. Write down topics that come up which you need to go home and read up about – follow through with it. Interns are a wealth of knowledge, it wasn’t too long ago they were in the same position as you, ask them questions and listen to their suggestions.

Be keen and willing to learn. Someone who shows they want to learn will be taught more and given more responsibilities. Put in the time and effort you think is necessary for you to reach your learning goals. Ask to participate and ask for opportunities to practice your clinical skills or to broaden your knowledge. Try not to decline a learning opportunity that comes up.

Be that medical student you would want to be partnered with. It’s great when you’re paired with another student who’s friendly, encouraging and easy to get along with, who’s knowledgeable but not cocky, who helps you learn without stealing your thunder, who can shine without throwing you under the bus, who’s not the super keener but not a lazy bum, who’s respectful of patients and confidentiality, etc. But it’s even more important to try and be that person for others. You surround yourself with the people you deserve, so be deserving! 🙂

Bake. Everybody loves home baked goods. If you can bake, you should share that deliciousness. No one will fault you, people will love you.

Keep up with your studying. Cramming doesn’t work anymore. Unfortunately, you have to remember everything you learn and build upon it. It’s hard, I know, I’m continuously working on this point.

Eating is important. But don’t just eat, eat healthy – your body will thank you. Also keep snacks on you – granola bars, nuts, chocolate, etc. They will save your life when you are too busy to take a break.

Get enough sleep. If you function well with 5 hours of sleep, that’s great. If you need 7 hours – make sure you get it. That also means you need to time manage well. Don’t sacrifice your studying or your eating time to make more room for sleep. You really need a balance.

Do things that make you happy. Keep up with your hobbies, take up new ones, see your friends, have quality time with your partner, take time for yourself to rest and relax. Otherwise, you will be lonely, stressed, and crazy.

I’m sure there are lots more that I can’t think of at the moment! 🙂

What about you? Do you have any tips?

GP: Coming to an end

Friday will be my very last session at the clinic for my GP rotation. How quickly 6 weeks have gone by!

We will having our final exams next week:

A multiple choice question exam on Wednesday and 2 oral exams on Friday. These are 13 minute stations (with an additional 5 minutes perusal) where we will have to perform a diagnostic case and a management case.

For the diagnostic case, we will have a patient come in with a presentation where we will have to take a history, talk through the physical examinations, provide our probability and differential diagnoses and lastly, provide a list of problems that should also be addressed.

For the management case, we will be giving a patient the diagnosis of their illness and will be working with the patient to manage their health. This will include assessing the patient’s knowledge, educating them on the diagnosis, coming up with short and long term management plans, taking the opportunity to discuss preventative health issues, providing resources, planning to follow up and safety netting.

Am I scared? Extremely!

There’s lots of time to study from now until then. I will definitely continue to practice cases and make sure I actually know how to manage diseases! I think the worst thing that could happen is to walk into a scenario where you have no idea what the disease is, let alone how to manage it!

And after next Friday – ONE WEEK HOLIDAY – YAY!

Note to self: Buy a stop watch for exams. Managing your allotted 13 minutes for oral exams is impossible if you have no idea how much time you have left.

GP: Flu Shots

This rotation, I have mastered the skill of giving flu vaccines. Hurray!

The very first time I tried to give a flu shot, the needle didn’t even break the skin – embarrassing!

But now, when people respond with, “Oh, you’ve done it already?” after I tell them, “All done!” I know I’m doing it right.

Important points to know about the flu vaccine:

  • Flu shots protect against certain strains of Influenza A and B by causing your body to produce antibodies that will recognize and fight against the flu should you contract it.
  • It takes 2-3 weeks for your body to produce these antibodies. If you get the flu within 3 weeks after receiving the flu shot, it’s most likely because you didn’t get the vaccine in time.
  • 100% protection is not guaranteed, so there’s still a chance the vaccine will not prevent you from getting the flu.
  • The vaccine does not contain live virus – the vaccine CAN NOT give you the flu.
  • There is a small chance of a severe allergic reaction to the flu shot – that is why everyone is asked to stick around for at least 15 minutes after receiving the vaccine to be sure.
  • Side effects of the flu vaccine include: local reaction (redness, swelling, pain, etc), headache, sweating, fevers, muscle/joint pain, fatigue, etc. These side effects are normal and should go away within 1-2 days.
  • Protection lasts around 12 months, which is why you need yearly vaccinations.
  • Children between the ages of 6 months and 8 years of age receiving the flu vaccine for the first time will need 2 shots, one month apart.
  • The flu vaccine is recommended and safe to give to women during any stage of pregnancy.
  • There are 3 main brands I’ve seen at the clinic: Fluvax (do not give to those under 5yo), Vaxigrip (Junior version for 6-35mos old), and Intanza (different delivery system – upper layer of skin rather than muscle. Causes more of a local reaction. For aged 18+)
  • The flu shot here costs around $15-20, but a person may qualify for a free shot they are: 65+ years old, Aboriginal and Torres Strait Islander 15+ years of age, pregnant, have one of the listed medical conditions (ie. heart disease, severe asthma, chronic lung disease, diabetes, etc)

And remember to let your doctor know of any concerns or side effects 🙂

GP: Way of Teaching

I’m happy to say I have a great preceptor at the clinic where I’m doing my GP Rotation. A teacher with lots of patience who provides many opportunities for learning and always answers my questions, no matter how many I ask.

He also goes by the motto of, “See one. Do one. Teach one.”

That means, for any procedure he feels comfortable allowing a 3rd year med student to perform, I am expected to watch him do it once, during which he talks me through the entire process, giving pointers where appropriate. The next case that comes in, I’m expected to be able to do it myself. Talk about my heart beating faster!

The next Implanon (contraceptive implant just under the skin) removal, punch biospy (sampling a suspicious skin lesion), sebaceous cyst popping (pretty excited for this one), etc – I get to do!

It is amazing how much medicine you don’t learn from textbooks but from a teacher and experience!

GP: “I can tell when my BP is high”

The last patient I saw the other day was, according to my preceptor, a “heart sink” patient. The kind of patient you see on your list that makes you sigh and hang your head in frustration.

This man had uncontrolled hypertension (high blood pressure – BP) simply because he is extremely non-compliant with his medication. He’s visited the clinic numerous times in the past but doesn’t agree on the importance of his medication, despite detailed explanations each time.

He came in with his wife, who said he still hasn’t been taking his medication and when we asked him why, he said, “Because I only take it when I feel my blood pressure is high.”

We asked, “Do you feel that your blood pressure is high at the moment?”

He responded, “No, because when my blood pressure is high, I can feel it in my ears.”

So we measured his BP, it was 190/80 – which was high, and we told him that. And for the umpteenth time, he was told about the importance of maintaining good BP and that he was at risk of having another stroke – apparently he’s had 3 already, one which took 3 years to recover. He’s also on Warfarin (blood thinning agent) so if he were to have a hemorrhagic stroke (burst blood vessel in the brain), it would be a big one that could potentially kill him or cause major complications.

He laughed and said, “I’ve already had 3, I will just have a big one then!”

His wife chirped in, “If you don’t control your BP, you might die tomorrow! You can’t leave me, I need you!” He replied with another laugh.

Needless to say, the consult ended up a waste of time because the patient refused to take the doctor’s advice. On the way out he apologized with a smile and said, “I’m sorry for my… indifference regarding my treatment.”

Perhaps one of the most difficult aspects of GP for me – knowing that your patients know their behaviours (smoking, not taking medications, etc) are putting them at risk of serious illness but despite your continued efforts, they simply don’t want to change.

GP: A New Rotation

Two weeks into my second rotation – General Practice

Michael and I are happy to be at the same place this time, yay! It’s a huge clinic with over 15 doctors and a plethora of other staff members. Due to the huge size of the clinic we are really looking forward to seeing a vast variety of patients, diseases, and procedures. Everyone has been extremely kind and welcoming, I’m sure this will be a very valuable rotation 🙂

I’ve already seen so much, but still a lot of studying to do – won’t be long before my preceptor makes me run my own show! He goes by the teaching motto, “See one, do one, teach one.”

Happy Easter everyone!

Rotation 1 complete!

Today I completed my first exam, and thus my first rotation of Year 3 – hurray!

Our Medicine in Society – Geriatric Medicine exam was 1.5 hours with 40 multiple choice questions worth 80 marks, and 1 short answer radiology question worth 20 marks.

The exam was overall fair and representative of what I learned this rotation in geriatric wards. With that being said there were still a number of tricky questions, so hopefully I did well!

Now that that’s over, do I have vacation?

Why yes indeed!

I’m off until March 18, which will be our first week into Rotation 2 – General Practice.

Mike and I are actually at the international airport right now, 3 hours after exam! Heading to Vietnam until next Sunday and stopping over in Singapore tonight. My mom is currently in Vietnam, so we are meeting up with her to visit some family and do some quality relaxing on the beach! 🙂

Plans tonight in Singapore: Chocolate Buffet on the top level of the famous Marina Bay Sands! Mmm, is your mouth watering? Because mine is! We plan to try all 57 chocolate varieties they serve, wish us luck! And of course, we definitely have to check out Gardens by the Bay and photograph the supertree groves! So excited!

We are also flying with Singapore Airlines, so looking forward to a nice and relaxing flight, especially after the exam!

Plan to blog whenever I can during vacation, come back and visit!

Have a lovely day everyone! 😀

MIS: Coming to an End

After an amazing 6 weeks at Prince Charles Hospital learning so much about Geriatric Medicine, my Medicine in Society rotation is coming to an end.

You would not believe how worried and anxious I was to begin working in the hospital this year. The thought of constantly feeling stupid and not knowing enough was enough to get my heart racing. Luckily I was proven wrong. Every staff member I have met at The Prince Charles Hospital has been welcoming and kind. Not only have they taught me so much, but they trusted me and provided innumerable opportunities to apply and broaden my knowledge and skills – I couldn’t have asked for a better experience!

Here’s a review of what happened:

I spent my first 2 weeks in the Fractured Neck of Femur  (#NOF) Service (01/21 to 02/01). All patients in this ward had broken their hip and required surgery and rehabilitation.

Then I moved on to the Geriatric Evaluation and Management (GEM) Unit for 2 weeks (02/04 to 02/15). These patients can have any sort of health problem, and were in GEM for further rehabilitation or waiting for home services to be set up before going home.

Fifth week I spent in the Cognitive Assessment and Management (CAM) Unit (02/18 to 02/22). This ward is more long-term and all patients have some kind of dementia. CAM was an especially unique and enjoyable experience. I got to know all the patients on a personal level and it was admiring to see how the staff take care and handle patients when they are being difficult.

During my last week (02/18 to 02/22), I spent a few days with the Geriatric Referral and Liason Service (GRLS) and some days back in the CAM Unit. The GRLS team takes referrals from all different wards of the hospital to see if patients would be appropriate for transfer to the GEM unit or elsewhere. GRLS was especially beneficial because I was able to learn how referrals work and got to become more familiar with other wards in the hospital.

We now have this week off to study for our exam on Thursday! And also have to finish up our health projects. For mine, I’ve created a medical information brochure for the Fractured NOF Service. I’ve received patient/family feedback and it’s now in the final stages of editing before being submitted to the forms committee.

Overall, I’ve extremely enjoyed my Geriatric Medicine rotation. I have had so many encounters with patients, their families, and health professionals that have taught me more than any textbook could. Thank you TPCH for a wonderful experience! 🙂

MIS: Chart Writing

As silly as this may sound, one of the most exciting things I’ve done on the wards is writing in patient charts. It gives me a satisfying sense of responsibility and makes me feel like a trusted member of the team. But that could just be me!

10 things I’ve learned regarding patient charts:

  1. The whole world would be happier if charts were electronic.
  2. Everyone on a multidisciplinary team has better handwriting than doctors – MUCH better.
  3. Sometimes, doctors really do have nice penmanship and you are so so grateful.
  4. You spend a lot of time looking for charts because another person on the team is using it. Refer to #1.
  5. You need to put a patient sticker on every piece of paper in their chart. Things fall out of plastic sleeves and papers get ripped all the time. Refer to #1.
  6. You are happy to see that the file you’re holding is “Volume 1” and not “Volume 7” because that means: the patient has not had lengthy hospital stays and you don’t have a ton of catch up reading to do.
  7. Forget white coats, charts are the dirtiest things around. They get carted around the hospital everywhere the patient goes, are constantly manhandled by innumerable hands, and never get cleaned… ever. Refer again to #1.
  8. It is always better to be more detailed than brief in your charting.
  9. Describing patients as “pleasantly confused” is a lot more common than you think, especially in geriatric wards – thanks to dementia. It sure took me a second the first time I read that description in a patient file.
  10. Unlike my seniors, I am not even close to mastering the art of reading through an entire patient chart in less than 5 minutes, while retaining everything I read. Got a loooong way to go.

MIS: Causes of falls

(In case you’re wondering, MIS stands for Medicine in Society – the rotation I’m currently undertaking, specifically in Geriatric Medicine)

Alright, moving on!

I’m currently in the Fractured Neck of Femur (broken hip) Service. That means, all our patients are elderly AND have broken hips that need repairing.

We admitted a number of new patients this week and as usual, needed to ascertain how they fell. There are a number of factors that can attribute to a fall, either extrinsic or intrinsic factors.

Intrinsic factors are things that are wrong within the body. This includes: balance and gait problems, visual impairment, medications, cognitive problems (ie dementia), cardiovascular problems, etc. Extrinsic factors include anything in the surrounding environment that could cause a fall – stairs, footwear, floors surfaces, lack of mobility equipment, etc.

As you can probably tell, it’s really important to find out the cause of a patient’s fall, because if possible, we want to prevent it from happening again in the future.

Asking our 80+ year old patient:

“And how did you fall?”

“I got blown over by the wind! If you can believe that!”

Resident and I just could not keep a straight face! An elderly woman carrying a pot of spaghetti for her neighbour (who just got out of the hospital) suddenly gets shoved from behind by a gust of wind (easily around 90km/hr during this storm week) and ends up in the hospital – the poor thing! She is lovely though, and her recovery is going well, which is great!

Wind = extrinsic factor 😉

I’m a 3rd year med student now – woo hoo!

Hello world!

Haven’t blogged in a long time, but this first week in the hospital has been insane!

What? In the hospital you say? Yes!

I’ll just start with a brief blurb about Phase 2 of our medical education 🙂 3rd and 4th years are known as clerkship years. Good bye are the daily lectures and hello to real world learning! We spend all our time in the hospital, going through 5 rotations a year learning everything we need to become the best doctors we can be. Each rotation is 8 weeks long, with one week orientation at the beginning and one week for review and exams at the end.

This is my rotation order this year:

rotation orderMy first rotation is Medicine in Society – specifically in Geriatric Medicine at The Prince Charles Hospital (TCPH). I had never been at this hospital and didn’t know what to expect. Additionally, although my clinical hospital is RBWH (5 minutes away) it would take 40 minutes to get to TPCH, ugh!

Needless to say, the thought of starting 3rd year terrified me. Imagining my constant lack of knowledge, being berated by my seniors, looking stupid in front of patients, etc.

This week, however, has been amazing! I am spending the first 2 weeks in Fractured Neck of Femur Clinic. In this ward, we work in a multidisciplinary team to care for patients who have broken their hip and will require surgery, making sure their pre and post-op care is complete.

I feel extremely lucky to have been assigned to a great medical team which comprises a geriatrician (GeriDoc, my preceptor), a registrar (Reg) and an intern (Resident). Mornings are spent doing ward rounds with Reg and Resident (GeriDoc joins us at least twice a week), lunch times are often spent in meetings and afternoons are spent doing ward work.

I have learned an amazing amount in such a short time. The most important thing I’ve learned is not the medical knowledge, but how to work in a ward. Understanding the dynamics of working with other staff members, knowing where to find things, learning procedures and protocols on tasks like prescribing meds, ordering bloods and imaging, etc. Being comfortable on the ward and with others is the first step to success I think!

Reg and Resident have been instrumental in my positive experience thus far, especially since I spend all my time with them, and for that I’m very thankful! They are kind, patient at teaching and do not hesitate to give me opportunities to learn and make me feel a part of the team. Although he’s quite busy, I have also spent some time with GeriDoc and he has been more than encouraging. I will be spending more time with him this week, so I’m nervous but anticipating lots of learning.

My only complaint? I’m so wiped by the end of the day! I leave the house at 7am, get to the hospital before 8. Have a bit of time to review recent tests before handover and ward rounds start. Go all day, sometimes no time for lunch, and finally home around 5-6pm. If I’m lucky, earlier! By the time dinner is over, I can barely keep my eyes open to study 😦 Slowly getting used to it though!

Believe it: I’m officially half a doctor! Yay!

Over a week since my results of second semester were supposed to be officially released and I have finally received mine. The wait has been agonizing!

I’m so happy to say that I passed, with my best semester yet, yay! 🙂 That makes me 1/2 a doctor! Haha

So happy to finally know with a certainty I passed, especially before going on my trip to Halifax 🙂

Oh, I haven’t mentioned that? I know 😛 But I’m going to Halifax (in a few hours) today for a week and will be back next Tuesday. I’ll be meeting Michael there and we shall frolic on the East coast. I have no idea what the plans are yet, but I will make record of what we do so that I can document it on my blog of course!

But for now, time for breakfast and a shower before heading to the airport! 😉

Have a great day everyone!

Home: Comforts and responsibilities

Like many people say, home is where the heart is. But after being away this year, I felt a little estranged walking in. I guess it’s simply because certain things changed and I wasn’t around to witness the process. Even little things like a replaced mat, a new appliance and small cracks in the old paint are taking me by surprise. I’m actually spending time staring at them!

I’ve also almost forgotten how much busier you can be when living in a family household, especially as the older sibling/eldest child. Someone can always use a hand, something here or there can always be done, and there is so much catching up to do when you’ve been away for so long!

I’ve come back right in the middle of home renovations, which are always such a joy! (Note: Sarcasm) Completing renovations is always very satisfying, but the potential long journey to that point is often tiring and can really test your patience. However, there are still good aspects of undertaking such projects, such as hanging out with family and using my non-existant muscles – which are already feeling the burn. We’ve barely made a dent in anything so I can’t wait to see how happy my body will be by the time we’re done. (Note: Very serious, no sarcasm meant. I really need move my butt)

The current state of our study. Hopefully the next time you see it, there will be no messes!

Besides family (and friends whom I have no time for yet) and the bed, there are many other comforts of home I often take for granted, primarily FOOD.

Things like, Cinnamon Toast Crunch cereal… the taste you can see!

Vietnamese dishes I would never make myself like warm Soy Bean Pudding with ginger syrup, perfect for the cold weather!

Additionally, I’ve forgotten how many delights a fridge stocked by my mom can contain! 😛

My sister still has her claim on my old bed. She’s joined both our twins to make a massive… king sized? So she’s stuck with me in ‘her bed’ along with her life-sized teddy. I sometimes worry he might come to life and kill me in my sleep.

She’s also bought a new pet – a 5 month old yellow bellied slider turtle, which she named Franklin. Very original name, I know 😛 As you might see, his shell looks pretty unhealthy. Franklin’s previous owner didn’t take the best of care (provided no proper heat/UV-B lamp… the poor turtle) so my sister is making sure he’s getting a lot of love.

I’m also still debating on whether or not I will write the USMLE Step 1 and if so, when I will be writing it. In the meantime, I’m still going to study over the break. Pocket medicine was the only physical book I brought back with me, but everything is on my iPad, so should be fine! I’ve decided to begin studying by going over Pathoma lectures, starting with Chapter 1 today. We’ll see how that goes before I plan anything further! 😛

And while you’re here, I wanted to share with my year book profile – written by Roger and Christine with a few things added by Michael and Yoni (yes, we were supposed to get our friends to write one for us). After reading the profiles of many other classmates, I’m quite thankful my friends are nice and don’t have a cruel sense of humour! 😉

Photo #241: Last PBL Ever

October 26, 2012

Today was our last PBL session… ever! How quickly did this year fly by? I’m really happy to have been a part of such a wonderful group of people. You guys have taught me so much and made me laugh even more! Thanks Christine, Yoni, Roger, Chen, Alex, Jasmine, Joseph, Randol, Josiah, and Drew (our tutor)! All the best on your final exams!

Photo #233: USMLE… sigh.

October 18, 2012

Tonight, I made the decision to write the USMLE Step 1… hooray… sad face. 😦 Finally took a serious look at the First Aid book I bought last year and a part of me died inside. There is a lot of material to know. I should’ve decided to write this earlier. Why am I doing this to myself? Oh wait, I should already know all of this stuff… it’s the thought of having to remember everything inside out that makes me cry. At least I can now say I’m not closing a door to my future!

OSCEs over and now the wait starts

3 weeks ago, I mentioned my year 2 clinical exams (OSCEs) coming up.

Well, I’m happy to say they are finally over! As part of the first batch of students taking the tests, we were scheduled to be at the hospital by 8am today. I was so nervous and worried that I woke up at 5am to read through everything again… 5am! Very rarely would I wake up that early because I’m so stressed!

At 8am, we were ushered in a conference room in the Outpatient Clinic at RBWH. We were signed in, divided into groups of five and were notified of the station we would be starting with. After being given a lovely speech of encouragement from our program director Dr Schafer and once everyone was ready to go, we were directed to our respective hallway and proceeded to sit down at our first station.

There were a series of 5 stations. At each, we had 2 minutes to peruse (and make our way from the previous station), followed by 8 minutes to carry out the specified task. 10 minutes total per station.

I started with Station #3: Clinical Reasoning.

The blaring horn went off to signal the beginning of 2 minutes perusal. At this station, the patient presented with abdominal pain. I had to read through the complete history and come up with 3 likely diagnoses and support them with positive and negative findings. Two minutes flew by so quickly, I had barely read through the entire history and only had just written down my diagnoses. The annoying horn went off to let us know 2 minutes was up and it was time to proceed into the room. For this station, I get an additional 2 minutes to collect my thoughts before speaking. Before I knew it, it was time to start. This station overall went well for me, although it wasn’t until I stepped out the door that I realized my 2nd diagnoses should’ve been my first!

Next was Station #4: Clinical Communication Skills

Two minutes to peruse how I would facilitate a ‘behavioural change’ discussion with a cardiac patient who needed to quit smoking. Prior to today, this was the station I was most worried about but I think I did fine. Hopefully I addressed the patient’s concerns appropriately and explored the necessary details. I said the patient was in a contemplative stage but unfortunately, didn’t have time to completely wrap up the interview.

Station #5: Procedural Skills

A sigh of relief. I looked down at my sheet during perusal to see the choice of skill to be tested was a less complicated one. I didn’t have to do venepuncture or cannulation. All I had to do was take BP, RR, HR, and measure peak expiratory flow. This was the only station which I finished (comfortably) within 8 minutes. Thank goodness.

Station #1: History Taking

A woman presenting with fatigue and weight gain. It was a classic hypothyroidism case. At one point during history taking, my mind blanked and I had a long awkward pause followed by putting my hands over my face and mumbling, “Ah, I’m sorry!” However, I did pull it together and thought I took a decent history, even though I forgot a few specific hypothyroidism questions (ie. nail changes and thickened skin) I also ran out of time, so had to blurt out that I would also want to address the patient’s family/social history.

And lastly… Station #2: Clinical Examination

I was asked to do an examination on a patient with a suspected diagnosis of lung cancer. This was the station I was most prepared for but I don’t think practice can ever prepare you for an intimidating (almost rude) examiner. I felt he was really aggressive and didn’t let me finish anything I wanted to say. I started with asking the patient his age (check if hes oriented to person/place/time) but before the patient could answer, the examiner yelled, “Why would you ask that? You were told his age on the paper! It says he’s 48! … Oh, well his mental state is fine!” Every time I mentioned that I would be looking for ‘so and so’ and before I could actually touch the patient, he would cut me off and loudly say, “Normal!” … every time! As a result, I could barely ‘examine’ the patient. I was also told to move on to other parts of the body when I knew there were things I needed to mention but didn’t get the chance. By the end of the examination, I had only been allowed to do a few percussions and feel a few lymph nodes. One stupid mistake I made: not realizing I had said ‘hypertrophic pulmonary osteoarthritis’ rather than ‘-arthropathy’ and not cluing in when he repeated ‘arthritis?’ I am genuinely worried about failing this station because I felt like the examiner did not judge my ‘examination skills’. Instead I had to verbally stutter my way through the station because I wasn’t really given the chance to fully talk or examine the patient.

Even though we were told not to fuss if we didn’t finish a station, I can’t help it! Oh well, I guess all we can do now, is wait and see!

Things I enjoyed:

  • It’s nice to have the skills I’ve learned these past 2 years be tested. It’s obviously necessary if we want to perform well next year on the wards!
  • Very well organized and very grateful to all everyone (staff, examiners, patients) who made the day possible.

Things I wish could’ve been better:

  • 2 minutes perusal time includes leaving the previous room and settling into the next station. Then 8 minutes at the station includes entering a room and having a brief introduction with the examiner. The seconds are so precious and add up quickly… I would have liked to see more time allotted per station.
  • Perusal during clinical reasoning was quite distracting when you could hear the other stations through the walls!
  • I had mostly good experiences with examiners but also one particularly bad one. From comments on our FB page, it seems many other students felt the same way. Just as our patients are standardized, I wish our examiners were as well. I wish they had been specifically instructed on how to evaluate us. Discrepancy with examiners can lead to an experience like mine or like others who were able to perform (while verbalizing) an actual examination on the patient.
  • The alarm/horn was so nerve wracking! Please use a nicer sounding chime (like Westminster) next time, and NOT THIS – gives us mini heart attacks each time.
  • As examiners pass or fail us on the spot, it would be great if we could get our final P/F grade at the end of the OSCEs. But logistics makes it understandable.

The wait begins…

5 more weeks of school

I cannot believe there are only a few more weeks of second year medicine remaining… how time has flown!

I’m starting to feel a little stressed as there is still a lot to do before the year is over! In just 2 weeks, I will have my Objective Structured Clinical Examinations, more commonly known as OSCEs. I must pass this practical exam, as well as my written final exams, in order to move onto third year.

The OSCE will be a series of 5 stations and I’ll have to pass each one. We’ll have 2 minutes for perusal at each station followed by 8 minutes to complete the task.

The stations will be:

  1. Taking patient history
  2. Performing a patient examination. This might be focused on a specific symptom/joint or it can be generalized to any given system.
  3. Clinical reasoning. Given a patient’s history, examination and investigation results, I will have to give a series of potential diagnoses with relevant positive and negative findings of each.
  4. Procedural skills. A number of skills could be tested, including venepuncture, cannulation, blood pressure, BLS, etc
  5. Communication skills. Could be facilitating behaviour change, breaking bad news, etc

Am I worried? Yes, definitely! Will be practicing every day from now until then. I am also part of the first batch of students to have their OSCE… scary!

And the rest of the year:

  • Oct 20 – a 10 minute group presentation in front of our peers for Global and Community Medicine. The topic our group chose is “Schistosomiasis in China” – should be interesting!
  • Nov 5 – Clinical Science imaging exam
  • Nov 7 – Clinical Science exam
  • Nov 8 – Ethics and Professional Practice exam
  • DONE EXAMS! Woo hoo!
  • Nov 10 – Halfway Dinner!
  • Nov 18 – On the plane home!

There’s a lot more to do before the holidays, but oh so close! 🙂

 

 

Procrastinating… as usual -_-‘

I have 2 exams this Saturday: Clinical Science and Ethics & Professional Practice.

Am I ready yet? No.

Will I be ready? Maybe!

But as usual, I’m taking many breaks to go on (what Michael likes to call) YouTube Adventures!

Join me for a smile as I procrastinate!

Medical Terminology Concerto
(Not everyone will find this amusing as I do…)

2 Hamsters 1 Wheel
(Mike laughed so hard, he cried – for real)

Sugar Painting: Chinese Dragon
(Such a low cost business and so good! I wish I had such a talent!)

and because one video is never enough

Painting on Water
(Reminds me of doing marble nails if anyone has ever done that before)

Flexipan Small Cakes
(I really really want these pans now…)

Funny Japanese Pranks
(Because they never fail to make me laugh)

Gangnam Style!
(Come on… don’t tell me you haven’t seen this yet? :P)

Thinking about Phase 2 of MBBS

That time of the year has finally come!

As we head into the new semester, all second years need to start deciding where we’d like our paths to unfold for clerkship beginning next year.

What is clerkship? It’s when we stop learning in class (Years 1+2) and start learning in the hospital (Years 3+4). Finally, yay!

Year 3 comprises of 5 hospital rotations, each 8 weeks long and must completed in the following order: General Practice, Surgery, Mental Health, Medicine, and Medicine in Society. We can start with whichever rotation, but they must follow that order.

Year 4 will continue with more rotations in other specialties including Obstetrics & Gynecology and Pediatrics.

So now the question is, in which order do I want to complete my Year 3 rotations and more importantly, which Clinical School would I like to attend?

After much thought and consideration, I have decided to pick my current hospital, Royal Brisbane & Women’s Hospital (RBWH) as my first choice and hope to start with Medicine in Society.

Medicine in Society sounds particularly interesting. As international students, we have the option of organizing a rural rotation back home or stay in Brisbane and complete it in the field of Rehab, Indigenous Health, Geriatrics and/or Palliative. I don’t plan to go back to Canada for any rotations until 4th year, but I’ve always found Palliative Care and Geriatrics interesting!

Why RBWH? It has many perks including being a huge quaternary and tertiary hospital (largest in Queensland) and only a few minutes from home… 😀

I’m glad I’ve finally made up my mind. Our allocation system will be opening a week from today. I hope I’ll get my first choices!

Food makes me happy

My friend Amin told me that my passions are:

  1. Food
  2. Photography
  3. Medicine

He’s wrong… sort of. Those definitely are my current top 3 passions but not in that order… it changes everyday depending on my mood and how well my studying is going. Haha! 😉

Vietnamese garlic mayo – my mom’s recipe. One of my favourite with bread.

Banh Mi Xiu Mai – Vietnamese meatball sub with the garlic mayo above, meatballs, sauce and pickled carrots. There should also be daikon radish but I forgot to buy and pickle some!

Mike made some yummy guacamole!

Pasta salad with creamy mushrooms, grilled eggplant, red peppers and carrots 🙂

Lemon pepper crusted salmon and creamy mashed potatoes with sour cream and onions

Too much food, haha. Omelette with veggies, salad and bread

Eggs Benedict with cured salmon

No more blues!

So, the last entry I wrote made me really sad and really didn’t put me in the mood to write much in the last few days.

Medicine imposes high expectations and whenever I fall even a little short, I always find it a little hard to resurface and find my grounding. Yes, it is demanding but I do know it should never bring me down, especially when I’ve decided that this is what I want to be doing for the rest of my life. Continuous learning! 🙂

It’s extremely humbling when I’m always surrounded by very intelligent people from so many different backgrounds, but also have to remember that I’m not dumb and that I’m unique and capable too!

Except for those few downs, I’m really enjoying second year. I’m in the hospital a lot more this year, finally putting the skills I learned into practice. Speaking to patients can be difficult and daunting, but luckily, it’s been okay so far and I can only learn from mistakes! Clinical reasoning is something else I’ve been working at becoming better at too.

My CC coach has been great and we’ve been learning a lot from him. Thank goodness for his patience!

One of my PBL mates, Roger, is an optometrist with many years of experience. He kindly offered our PBL the opportunity to go into the practice he works at to have further experience using the equipment, including the slit lamp and how to properly check the health of a person’s eyes. It was a great because our Ophthalmology Workshop with the school was too rushed to learn everything completely. Thanks Roger!

We’ve also had the chance follow the Director of ICU at the private hospital we were at last year. So glad he was willing to have us around last week and that he’s up for having us come back again! He is an amazing doctor and teacher. In the 6 hours we were there, we saw all his patients at least twice and a number of procedures including the installation of a Greenfield filter, 2 TOEs (one with a cardioversion), and an endoscopy. An amazing day with tons of learning!

Have I mentioned that I still have catch up to do? So much to learn, so little time!

One of my favourite “pensive and inspirational” pictures:

 

I need to step up my game!

Me… a future doctor? Sigh!

I’ve been feeling pretty down lately. Seems like no matter in which direction I look, I am so lacking compared to others. Everyone seems to be hard working, on top of things, multi-talented, working on the side, super smart with great clinical skills.

And then there’s me. Constantly behind, easily distracted, lacking motivation and never getting over the habit of procrastination. Why?! I know I want so much more.

So… *mental slap* I hate feeling like this. Time to hit refresh and start second year over with a different mentality!

Vietnam Week 1: Thursday, Oct 27, 2011

[I have a lot to share regarding my experience at Cho Ray Hospital, but I will be saving that for a separate post later on]

Thursday was technically our day off, but we decided to go into the hospital until lunchtime. It just so happened that on Thursdays, doctors take part in weekly presentations. This week’s presentation was on ‘Pre-eclampsia & Eclampsia’ given by Dr. Ngan (works in one of the ICUs in the Tropical Diseases department). The entire presentation was impressively given in English, although I suspect our presence made her more nervous than usual. Following her presentation, her colleagues are given a chance to ask questions. The vice director (Dr. Phuong) and Dr. Hung were especially critical! Overall a good experience, we were glad to have come in.

By lunchtime, we were downtown in District 1 and ready to start exploring. Unfortunately, I’ve already seen most things in District 1, but it was still fun to re-experience them with Mike and Kristen!

First up, the Reunification Palace! Absolutely nothing has changed here since I went last year… and to be honest, not worth visiting. Just taking a picture from the outside is good enough. Didn’t take many pictures because it’s all been done before (click here for pics from last year), but here’s a few!

We then walked over to the War Remnants Museum. Old artillery, tanks and helicopters are interesting and all, but we could not get over how they’ve twisted and presented history in this museum. It is very anti-American and full of propaganda… sad!

Proceeded to walk back to take a look at the Notre Dame Basilica and Saigon Post Office…

On the way back, we found this! Mini toasted baguettes with La Vache Qui Rit cheese, pate and chili… soo good! And for only 10 000 VND (less than $0.50). Street food yumminess!

We’ve labelled all the parks in VN as ‘snoggle parks’ because that’s what all couples do… go to parks to snog! Apparently, our mocking did not impress the man watching us…

Notre Dame Basilica with Diamond Plaza in the background

Saigon Central Post Office right beside the basilica

Inside the post office… Gringotts?!

We were supposed to have dinner with Annette, but that fell through so the night ended early back at our hotel!

A last PBL get together before exams

In celebration of making it thus far, PBL 25 got together to celebrate over lunch at one of my favourite restaurants – Madtongsan II.

Kristen, James, Fiona, Andrew, Christine (and honorary member Michael) – you have made Year 1 of the MBBS program awesome! So happy to have met all of you 😀

Good food with good people… good times!

Yum yum!

Waiting for the gang to arrive

Menu has so many great dishes!

PBL 25 love