Cut Up

Literally. In the Surgical kind of way. Haha.

I made a decision to go into Theatre bright and early on a Monday morning, simply because I had not gotten many chances to witness many big operations during Gen Surg last year, and hey, this is what a surgical rotation is supposed to be about right? Lots and lots of theatre and cutting.

Well not me cutting of course.

Turned up at 8.30 in Theatre on Monday, and was slightly shocked to see that no other student had beaten me to it, and that the Reg and SHO were not even there yet. So I hung around in the Anaesthetics room where the Anaesthetists ignored me, not that I cared much of course. I just read the patient's notes and kept myself busy till the surgeons came along. After that, CK explained to me that there was a code in the room where silence was maintained simply because they didn't want to agitate the patient any further / cause unnecessary nervousness before the big procedue. God knows, I would be SO nervous if I was going into an operating theatre, so I guess that makes sense.

Mr. T let me scrub in, and the Reg was the same one whom I had had from the Colorectal team in Georges last year, so all was quite good. Except for the SHO who ignored me, they talked me through the Anterior Resection and said I could scrub in. Although I felt later on that it was SUCH a waste of NHS resources etc, because all I did was scrub up to stand there like some kind of model. Touched the retractor for like 2 seconds, and the Diathermy pen for another 2 seconds to prevent it from slipping down, and the suction for another 3 seconds. I even felt sorry for the SHO whose job was just to hold retractors and snip suture. But I guess that's what being a Junior is all about in Surgery huh? You never quite get to actually do anything until you're a Reg probably.

Bar the initial excitement of scrubbing up and wondering HOW I could have screwed up my OSCE station in Gloving & Gowning last year, I eventually started wondering, throughout the duration of the 5 hours, what my purpose was as a medical student here in theatre. Was I supposed to gather anything by watching them do the surgery? It wasn't like I would be able to know what to do later on anyway. Sure, I knew that the patient had a Mid Rectal Tumour that was pretty large (Felt it on PR exam), and that they do Anterior Resections for these, and they do a temporary Ileostomy after to divert the flow of contents through the bowel just to let the anastamosed area heal for a while after surgery since the small bowel contents were the more 'nasty' stuff.

This was the amazing piece of technology that I found so fascinating - which they used to anastamose the remnants of the descending colon and the rectum. I was wondering for a moment, how they would have done it in the past without this Stapler, seeing as the lower rectum was all the way down in the pelvis and out of sight, and there was no way they could have sutured without being able to see. Then I realised they probably wouldn't have done Anterior Resections in the past, they would have just gone with AP Resections totally.

After a whole 5 hours of standing on a platform and talking through a mask, though, I got pretty tired.

Thank goodness for CK's pep talk outside her flat while walking back after dinner. I was just telling her how afraid I had become of surgeons in general, after getting yelled at by the CT Surgeon, experiencing mood swings in some others, and although Mr. T was probably the nicest surgeon I had met so far - I was still a little apprehensive. And I was tired. What was I supposed to gather by watching surgeries in theatre? Was I supposed to become any smarter and any better in surgery after this?

I don't overstep my boundaries as a medical student, and get out of their way whenever they are having mood swings, and they might think that I lack initiative. And if I do? I would just get told off anyway. And there are only so many times I can get told off.

So there's never anything you can really do right as a medical student, really. Damned if you do, damned if you don't.

I guess I am being a bit of a Drama Queen here. Don't get me wrong, I really do like Colorectal Surgery. Colorectal Pathology is this easy, you see. There are only so many things that can go wrong in your colon and your rectum. And the reason I like surgery is because everything is systematic, and broken down into bullet points. And there is a chronological system of categorising and thinking.

Reflecting retrospectively, I don't think that my experiences with Surgery have all been entirely horrible, and I really shouldn't be whinging about my team right now, seeing as they have actually been quite keen about teaching, but I guess I am the sort to lose focus easily and be affected by things.

I am lost in translation, but I guess it's just a matter of time before I get myself back.

I Miss...

.....you already.

=((((

Half-Heartedly

Perhaps I have just been influenced all weekend by John Mayer crooning to me across my amazing Altec Lansing speakers about not being able to give me more than 'Half of his Heart'. But honestly, some days I feel like I am going through my days like clockwork, just waiting for the sun to rise and then the days to turn dark again. And THAT concludes yet another 'sien' day of my life.

So yes, unfortunately I guess I am going through my Surgery days more half-heartedly than I would have liked to. And I can blame Epsom and the lack of patients to attend to, but that is just me picking a million excuses out of a hat without having to blame myself.

Looking back on the first week, I guess not ALL aspects of it were as bad as I had anticipated. First of all, travelling wasn't as bad. And I have yet to appear on hospital grounds at an unearthly hour, well except maybe, tomorrow.

I guess I should really be grateful that there is actually a Teaching Fellow around to offer teaching, and actually make the effort to bring us over to the neighbouring Trust hospital to hunt down more interesting patients. And the session on Thursday on Wound Management was REALLY useful, considering I had almost forgotten all the info I had collected from all the Plastics lectures I had in Georges last year. Plus, we actually got to perfect our suturing this time around, compared to how the ENT Surgeon whizzed through everything at tip top speed last year, and even though I won't say that I am Plastic Surgery material at doing Interrupted or Mattress Sutures as yet, I will say that I am better AND neater than I had expected. I know it takes a lot more to be a surgeon than to just be good at suturing, but it is just the satisfaction of being able to do something right and well, at least.

Thursday Colorectal Clinic lasted a record-breaking FOUR AND A HALF HOURS in the afternoon, and we got out at 1830. Both my firmmate and I were aghast at how many patients there were - some were waiting for a whole hour and a half. And personally, I was amazed at how passionate Mr. T was about his work. I got home at around 8 pm or so, but despite feeling completely knackered, I found some time to pause and consider how Mr. T might have felt in comparison. He had never lost his level of energy or enthusiasm one iota, throughout the whole four and a half hours of that marathon clinic, and there we were - merely sitting in the corner - not even having to actively think or act on managing, proceeding or breaking bad news, apart from answer questions every now and then - and WE were the ones feeling exhausted instead.

And that was when I felt that I had become more half-hearted at what I supposedly loved than I had realised.

During the days of pre-medschool interviews of tears and stress and proclaiming that Medicine was the only way to go, that there was no way I could imagine myself doing anything other than Doctoring my way through this link of people and clinical science, I was full of passion and ambition.

And somehow, halfway through this journey, I lost myself again.

A younger, more vibrant me would have been thoroughly amazed at that clinic session. To be fair, I was exhausted, but I KNEW that it was one of the most rewarding clinic sessions I had had the chance to sit in on. We saw the whole spectra of Colorectal diseases, and as Mr. T mentioned, there are only SO many diseases you can get in your large bowel - from harmless haemorrhoids, diverticular disease, the IBDs (UC & Crohn's), even a rectocaele, to the more frightening colorectal cancer. And we saw them all.

So on Friday morning I made myself go in on my own to get some stuff done. Having failed to hunt down any of Mr. T's surgical patients on the wards, I bumped into the F1 along the way and offered to help her with her jobs, as well as for any good patients to see. No surgical ones, but Ta-Dah! Cardiac Patient again! Hehe. Not a very flabbergasting history, to be honest. Possible NSTEMI, but I was grateful to perfect my Cardiac History Taking / Examining at any point.

So I will be looking forward to a hopefully rewarding Theatre session tomorrow.

And then after that, not really looking forward to Hanna's farewell dinner. Well, not really NOT looking forward to seeing the others per se, but you get the drift.

More about that another time though.

Meanwhile, I leave you with my favourite song of the moment:

http://www.youtube.com/watch?v=Lwd0h6V_4fU

Half of my heart's got a grip on the situation

Half of my heart takes time

And half of my heart is part of a man

Who's never truly loved anything

The Lakes

In not so many words.

Xixi brought up the term of 'Seasonal Affective Disorder', and I voluntarily claim myself to be guilty of it, through and through.

Then again, weekends are always something to look forward to.

16th October - Weekend Getaway to Lake District:

Kudos to Nick's amaaaaazzing camera! This picture really DOES do the place justice.

And this is hilarious. Boyband album cover much??

Also, special mention to Nicholas 'Nod' Yeap for slowing down his pace to match mine while the fitter of the lot trudged ahead. Lol. Much appreciated, buddy!

Not THAT Kind of Girl

Mini weekend getaway to the country.

AKA Lake District, Cumbria.

Was feeling extremely knackered all week and was wondering if I would be too exhausted to properly enjoy the outing, but again, I underestimated a trip with the kawans.

Beautiful place. Peaceful. Cold......BUT at least it wasn't raining. Very much welcomed from the hustle and bustle of London. When I was being jostled and shoved and almost knocked off my feet today in Victoria Station, I couldn't help but recall and embrace the lack of human capacity, where I could actually SEE miles and miles of unpopulated land at the Lakes.

Unfortunately, this was the response I got on two separate conversations after I got back.

#1:

hpy: How was the trip?

me: Good! Except we were hiking for 4 or 5 hours on the rocky footpath and my leg muscles AND feet hurt so much. Also I looked so damn out of place in my attire!

hpy: WHAT???? Just like Edinburgh?! Don't tell me you wore high heels!

me: *speechless* Why are you asking me the same question again?!

#2:

Jenn: Shing! How was Lake District?

Me: Good good. Really pretty! Except I wasn't exactly using proper footwear or gear and it was kinda tedious hiking for 4 hours!

Jenn: What improper footwear? Don't tell me you wore heels.

Me: OMG why is everyone asking me the same thing? Why would I wear heels to go hiking? Pffttt.

Jenn: HAHAHAHHA because you are sooooo predictable like that, Shing!

And this is coming from the two ppl who are supposedly the closest to me and have known me well for 7 whole years!

HMPH. I may like Minnie Mouse, and I like anything with a bow, and I wear heels on normal, non-hiking trips (because I am short!), and I do not own anything that is remotely North Face....but I am sooooooo not that kind of girl.

Pffttt.

Next purchases: Timberland boots, North Face parka, Deuter backpack. Watch this space!

In the meantime, here are some moments to remember:

Pssttt. Look at my shoes. Sneakers! No heels! I know my attire looks odd. But please ignore that. For the record, I had no idea we would be doing full blown hiking AND I have no proper outdoorsy clothes here with me in London.

And regular meetups with you are what keeps me sane throughout the year.

Distance makes the heart grow fonder. And yes, I say Best Friends are Forever :)

Cardio God

This week has been a week of ups and downs. I started off the week with much stress, listening to MTAS conversations and coming to the conclusion that my future might be, perhaps, bleaker than I had ever imagined.

Then I decided it was possibly too late to lament any longer and decided to pro-actively try and be more involved in whatever clinical rotations I still had left before deciding my fate next year.

Much of what I discovered about myself this week was probably not very pleasant in many ways. Admittedly, I am not as nice a person as I would like to be, and can be rather opinionated, very evidently, about personalities that tick me off. And one of those are, perhaps, medics who are in the field for the completely wrong reason. Recently, a friend voiced his opinions to me about venturing into Investment Banking and Finance after having sat and passed some Surgical specialist exams. At that point, I was rather apprehensive of the idea, and said exactly so.

And then I realised that I was perhaps being unjustifiably judgmental about people's futures and their lives, when who in the world was I to say anything. I had learnt a very long time ago that the world was just becoming increasingly fake and more superficial from year to year, and I could possibly be one of those too in the near future. And as sincere and passionate as I would like to think myself out to be, I am not entirely sure that I REALLY am. Especially at this point in time.

Sometimes I really just wish I could get married after qualifying and be a Chronic SHO forever.

HAH.

On a perhaps, happier note, today is one of the days I would like to remember, simply because it was a whole 2 years ago that I last watched an open heart surgery at IJN - and that has definitely been too long.

Prior to some warning that previous students had been increasingly told off for appearing after 8 am and not having clerked the patient in theatre beforehand, I attempted to locate the patient yesterday afternoon to clerk - only to be told that no one had any idea what time they would be turning up, be it afternoon, night or early this morning.

Did NOT want to mess up my only chance of watching a cardiac surgery (only one theatre day for CT Surgery out of the Cardiology placement), so I stumbled into the still dark hospital at an unearthly hour to try and clerk the patient beforehand. Bumped into this woman in stiletto heels and a white coat and made the mistake of not recognising her as the Cardiac surgeon doing the operation, and got told off severely for trying to clerk the patient before the surgery, hence potentially stressing the patient out - and that I should have done this yesterday.

Decided not to argue, because I felt that she did have a point, but she turned out to be alot nicer in the end. She was demonstrating a Mini Aortic Valve Replacement (different from the standard AVR in the sense that they were not doing a full sternotomy) to about 20 other surgeons / anaesthetists present that morning via video conferencing, and she said we could watch but couldn't go into theatre because it would probably be overcrowded.

Fair enough. Turned out to be amazing!! The view was better than any I could have asked for. And there was no way any CT Surgeon was going to let a medical student scrub in on his/her major open heart surgery anyway, so I figured there would not be any point going to stand in theatre and try to disappear behind into the walls.

My firmmate, who was initially extremely ticked off for not having been able to actually go into theatre today, ended up seeing the bright side of things just as I did, and agreed that this was possibly alot more useful than having been there physically. Fair enough, the jargon of Cardiothoracic Surgery remained. Arterial, venous cannulas for bypass, where to place holding sutures, what retractor to use, which situations to be wary of.....and when the patient when into resistant VT/VF towards the end, my firmmate was on the edge of her seat because the multiple attempts to defibrillate did not work - and yet much of me felt SO in awe of Prof J because she hardly batted an eyelash. In the end I think the anaesthetist gave the patient Amiodarone which settled, but it was definitely a bit of a hairy moment.

It is strange, when I reflect back, how a whole pool of people (larger than I would have imagined), have written me off as a Cardiothoracic surgeon wannabe. When I was 13, I distinctly remember filling in 'Neurosurgeon' as my 'type of Doctor I hoped to be'. By the time I was 18, after a bunch of wide-eyed, innocent, 'taster' medical attachments, I guess I was sort of thrown into the Cardio ocean by default, simply because I spent the most time there, because it was the easiest to just follow my uncle around.

Who knows, maybe familiarity stems interest? Maybe ignorant attachments do sort of influence the kind of affinity you have towards a specialty, because I still maintain that Ob Gyn horrifies me to this day (we'll see when I do that rotation for real next year). 2nd year 'electives' after that saw me doing Cardio again, simply because my initial plan failed. Again, no regrets. Cardiology was amazing. I loved the Reg I was with. Cardiothoracic Surgery, even more. Perhaps it had to do with the fact that the CT Surgeon became my best friend towards the end, but generally my experience with Cardio has been generally good.

I do maintain that I am biased, though. Mind over matter. Most of my good experiences have come from good teaching and camaraderie with teams I have worked with in the past. My first Gen Med consultant was a Rheumatologist, but that was probably one of the crucial moments that I realised I was more of a Medic than a Surgeon.

I sing no praises for my Cardio rotation. Georges has apparently one of the biggest Cardiothoracic Units in the South West of London, but the nicest thing I can say about the timetabling and the rotation is that it could be less haphazard, at the very least. And yet my preference for it has not faltered one bit. I wish I could have been allocated more clinic slots. I wish there were less people being rotated around and chucked into different things on different days. I wish I could have brought my murmur-identifying skills that much further. But I will just have to make do with things and lament less.

As a renown Cardiologist I know likes to say, "Do more, speak less. Prove by action."

Will do, will do.

Here's to Gen Surg next week. I'm sure it will be good.

Cardiorespiratory Arrest

I am stressed out.

I am frustrated.

I am edging on being depressed.

And strangely enough I am not even the one filling out my application for MTAS.

Maybe because I know I am most probably going to kiss my dreams of becoming a Cardio God goodbye.

And maybe because I haven't been studying like I am supposed to even though CK keeps saying 'I am always studying', just because she asked me on two occasions that I was 'supposed' to be.

Should have studied harder. Should have tried to be a more gungho medic. ARGH.

Through Thick and Thin, For Better or Worse

I came to take an interest in Singapore's Power Family, Lee Kuan Yew and family, after the initial exposure in Malaysian Studies sessions, when Mrs P would go on and on about how amazing Lee Hsien Loong was. How well educated all three of LKY's children were. And then later on, after some input from Bao, how pretentious Lee Wei Ling's weekly column in the NST was in Singapore - and how I can almost conclude that all neuro people are potentially just....weird.

And yet throughout all this, I had somehow managed to omit the presence of Mrs. Lee, despite the fact that she was on par, if not a step ahead of her husband, and her well-read children. It was only till recently through some mindless surfing and procrastinating on the net that I came across Lee Hsien Loong's eulogy for his mother, and subsequently Lee Wei Ling's.

But it was essentially Minister Mentor Lee's eulogy for his wife that brought a tinge of sadness deep within.

Reading through his reminisces of their times together that tracked all the way back from Singapore moments to relocating to Cambridge to read law, to marrying in secret, to all that they had managed to achieve before returning to Singapore, I couldn't help but feel copious amounts of envy. I remember reading somewhere once, when LKY recounted that the Western perception of marriage was to marry someone you love, and the Eastern way of looking at things was to love the person you had married - and that in this lifetime he had tried to do both.

And my bubble of cynicism burst, and I felt an overwhelming wave of sadness, when I realised that this was exactly how my grandmother must have felt when my grandfather passed on.

When you have spent more than three quarters of your life with someone, how easy is it to let go and continue living the rest of your life on your own again?

And then another bubble of doubt resurfaced, and I remembered the last scene in '500 Days of Summer', when Summer was telling Tom how she woke up one day and she just KNEW.....for sure, about what she had never been sure of when she was with Tom.

Hmm.....so through thick and thin......for better or worse.

What are the chances that everyone will end up like LKY and Mrs. Lee?

Heart-Stopping, Heart-Warming

So the last week of Gen Med passed by in the blink of an eye.

MAU was amazing, in more ways than one. The consultants, the pace of it, the many many teams bustling around, the way no one has time to speak more than the necessary 5 sentences to you, the way you think of yourself as being 'useful' by helping the On-Call team clerk patients first.

I love Acute Medicine. And was oh so pissed off initially when DB made me go to all the Onco MDT's etc after teaching because he was taking one whole day away from my MAU days! But I guess he made up for it after by going through all this incredible Cardio stuff with us. I haven't listened to an Ejection Systolic murmur in SO long. So hopefully more of that to come tomorrow.

And speaking of Cardio. I was catching up with a friend on Skype last week when she came up with this for me.

LOL. Call me cynical. Call me skeptical. But I guess it is easy to laugh it off now when you happen to not be the one in that position, hey?

Whatever doesn't kill you makes you stronger.

So Cardio next, and then after that Gen Surg at this amazingly wonderful 'hole' at the end of the world named Epsom.

So the theme of this week shall be Hearts. Heart-stopping although it may not be, but perhaps it will be heart-warming at the very least.

Cardiology, Cardiothoracic Surgery.... and I heart my neneks <3

So....heart-stopping palpitations, a drama-filled life, or the presence of someone who makes your heart flutter that much more......vs. the heart-warming familiarity of amazing friends.

Give me heart-warming ANY day. But know that true friends are irreplaceable, at the very least.

Thank God I found you.