New Beginnings

The end of one chapter, and the beginning of another. I think I have to be grateful for the fact that I am stressing out with 2389 things to do before starting work rather than have to sit on my ass and ponder about whether or not I will be nervous about not having the excuse of 'just being a medical student' to fall back on any longer. 

So, graduation came and went. After much fussing for months and months on end about what colour of an outfit to wear under the robe, what shoes to match them with, how high they should be and etc, we are finally holders of an MBBS degree (Bachelor of Medicine and Surgery). 

Could not have done it without the finances and undying support from my parents who have listened to me sigh, tear and stress my way through Medical School. Each time they have done nothing but give me anything under the sun that I desired and believe in my meager abilities. Kudos to Mummy and Daddy Sim! 

Onwards and forwards to new lives... and with them of course, comes the inevitable farewells. The three years spent with 'The Neneks' and 'The Cartoons' have served us all well, and I am positive that we will remain fast friends for a long time coming. Some bonds are just meant to be as such - unbreakable. 

Also, the biggest new beginning would be the huge move out of London down south to the sunny coasts of Dorset in South West England. Possibly 'the middle of nowhere', as Lynn's Persk Friend describes, but I get to play wannabe Cardio God for my first job, so hey, if anything I suppose there's always that to look forward to. It has always seemed strange to me that after all these years in the UK, I have not developed any sort of affinity towards it at all. Each time I prepare for another 13 hour flight back to the UK, the reluctance to leave home is truly overwhelming. As with most things in life however, I do appreciate that the grass is always greener on the other side. But the one thing I have been sure about each time people have queried me about my future plans was that there was no freaking way I would live in the UK for another ten years on end.

Then again, I suppose anything the one thing could happen. Perhaps my Cardio God aspirations will soon evaporate and be replaced with being an Investment Banker (IB)'s wife whose main concern would be which Balenciaga bag to wear each day. 

Actually, that sounds like a much better plan already rather than straining to hear Mid Diastolic Murmurs and picking up all the signs of Mitral Stenosis.

So Here's a toast to New Beginnings. Of surviving my experience as a Foundation Doctor and of making the most of my medical degree :)  (And my life as an IB's wife in the near future)

Licensed to Heal

When I was a little girl, all I had in mind was one thing: to be a Doctor. 

Somehow, it was just one of those things that I was sure about right from the start. At the age of 13, when we completed some profiles of each of our friends as an English project, my profile on Momo's page read:

Aspirations: Neurosurgeon. 

Of course, that has changed vastly since. Firstly, because I actually realised while on work experience how difficult Neurosurgery actually was, and secondly, in Med School that I was no genius. In fact, I was soooo mediocre, it was a huge piece of humble pie to swallow, realising that I was, in fact, hardly a dent in the pool of geniuses that made up a graduating year of medical students. 

Yesterday I passed my Med School Finals. 

We laughed, we shouted, we teared, we chugged down the alcohol, we partied hard, and then that was it. This phase of our lives was over.

The last Undergraduate exams of my entire life. A whole lot to take in. I struggled with ups and downs while trying to juggle sanity between OSCE-ing, calculating drug doses, placating people and laughing manically with my chums. Eventually, it seemed, I did know some Medicine after all in the past 5 years.

There have been brief moments in my life where I was fed a dose of reality of how tough Medicine really was. How much effort it took, emotionally and physically to be a great Doctor. How much my hand shook each year waiting to find out if I had passed yet another year and edged closer to becoming a Doctor, each time wondering aloud WHY I had chosen to put myself through such emotional turmoil.

At the end of the day, I say this over and over again, and I attest to this still. There is nothing else in this world I could imagine myself doing. I know I have yet to start properly Doctoring, but I do have high hopes for myself. 

The day I became Dr. S.

Another step closer towards possibly becoming that Cardio God :)

Sudden Cardiac Death

A Registrar once said to me, "This is why I like Cardiology. Everything just makes sense, you know. I'm not very bright."

I can't say I echo that remark completely for now - the stark differences being that I am no where near being a Cardiology Registrar yet, and I am sure that her definition of being 'not very bright' was vastly different from mine.

But I do see every now and again. That my overt preference towards Cardiology was never just an anchoring heuristic to begin with.

The term 'Sudden Cardiac Death' was almost foreign to me prior to my Clinical Medicine years. And now that I am approaching the end of my last EVER placement in Med School, I am being hurled with the terms 'Sudden Cardiac Death' and 'Cardiomyopathies' almost every other day. With all the hype about Fabrice Muamba collapsing in the middle of the pitch a couple of weeks ago and having to be resuscitated in public, I was introduced to the term of 'Non-Sustained VTs'.

Non-Sustained VT's : Ventricular Tachycardia of less than 30 seconds.

We were always taught to recognise the Ventricular arrythmias as the dangerous ones. VTs being no less so. 'Non-Sustained VTs' could progress into 'Prolonged VTs' and then eventually there was the risk of the heart arresting.

There you go. It could be Sudden Cardiac Death all over again.

I've never had an ECG in my life. I am sure that Fabrice Muamba never did regularly either. Who would have thought that a Premier League footballer would arrest for no reason in the middle of a football pitch. So in all essence, I could pretty much be at risk of Sudden Cardiac Death for all I knew. Lol. OK, I kid.

And this afternoon, I came up with a new term altogether: 'Gradual Cardiac Death'.

Clearly, I am becoming more and more insane with the manic mugging for finals than I thought. Because for a moment today, I thought that I would rather be a victim of Sudden Cardiac Death than a gradual one altogether. Although it seems that it is a little late to reverse things now.

Keep Calm and Carry On.

Vamos, Shing!

An Orthopaedic Heart

I once told a Gastro Registrar that my career choices lay between Surgery and Cardiology.

"What? Those two couldn't be more different."

"Really? What's the difference between surgeons and medics?"

"About 50 IQ points," he said. Typical Medical Registrar answer.

"What kind of surgery?"

"Orthopaedics."

I think he decided I was insane after that and walked off.

And then Mr. Agassi solved the mystery for me. Finally. Someone who found a similarity between the two. There must be a reason why I love Orthopaedics and why I equally love Cardiology.

In 1993, Andre Agassi was plagued with a ripping, searing pain in his wrist. His Doctor diagnosed him with Tendinitis. Specifically, Dorsal Capsulitis. Tiny rips in the wrist that refused to heal. The result of overuse.

A while later, the twentysomething Andre Agassi broke up with his girl of the moment. He told his trainer he felt shooting pains in his chest.

Sounds like a typical broken heart, was the response. Tiny rips in the heart that refuse to heal. The result of overuse.

(Open - Andre Agassi, An Autobiography)

Profoundly apt, in more ways than one. These days, my heart is set in bone. Yes, you read it correctly. A heart of bone. Notice how I am realistic, as such, because when bones fracture, we can fix them. Internally or externally. Outcomes are astounding. The less compound the fracture of the heart, the better it heals. Ah, now I see the perks of being an Orthopod. You see, you fix, you revel in a sense of fulfillment. Who knows, what career paths are to arise yet. It is a long road ahead as such. Cardio God or Orthopod, I welcome both with open arms.

But for now, let's focus on this.....or more appropriately, this case of an Orthopaedic Heart.

Almost Clockwork

I will admit that the past two weeks of my life have been particularly unfamiliar ones.

For one thing, it had become increasingly frustrating to be continuously on the end of being an F1's personal lackey. At first, it was alright. More of an 'I don't mind' mentality to being ordered up and down - taking bloods, faxing letters, being a postman to bring referral letters to clinics for referral. Simply because I was fast and it was pretty much routine. Clockwork, to be exact. No second thoughts needed.

Then it got worse. It started dawning on me how disastrous it would be to work with people who were disorganised or irresponsible or just plain blur in the future - and I wasn't referring to medical-knowledge wise but just plain common sense. It started getting to the point where I felt plagued with a sense of dreariness going to the stuffy ward office and sitting in front of computers doing endless discharge summaries. And then it got worse when the other med students on my firm became increasingly annoying and started asking me every single blur question under the sun. It got worse when I became expected to pick up alot of people's slack and even got the blame for things I didn't do just because I wasn't up for arguing and defending myself. And most of all, I felt that my brain had come to a standstill. It was terrible. It was bad enough that I wasn't the smartest cookie in the jar to begin with, but this had started hitting all time lows.

And then today, everything changed. At the risk of sounding dramatic, I suddenly felt alive again. My lack of tolerance for the haphazard fashion that ward rounds had been carried out drove me to go in at 8 am to sort out the notes and check all the obs for the patients, simply because Consultant teaching at 8.30 am would mean that everything would not be in place for later if I didn't take any initiative to do it. Who knew that a tiny gesture like that would have earned me multiple praises from the people I least expected them from, and even being labelled 'Star Student of the Day'.

But more importantly, for the first time in 3 weeks, after a useful bedside teaching session, I finally felt in touch with medicine again. I was finally thinking laterally and using my bank of differential diagnoses to work up a patient systematically. I was learning new things, revising my CXR presentations and mentally going 'Ooohhhhh' in my mind because my brain was finally working. I had forgotten the thrill of getting things right and realising that there are some things you actually had no idea that you actually knew.

Thank God as well for the random Vascular surgeon later on who came by our ward to review a patient and randomly started giving me an impromptu teaching session on Mononeuritis Multiplex and the different types of Anaemias that could present in a Rheumatoid patient. Despite my wariness with his brandishing a pair of surgical clamps excitedly around (don't ask me why he brought it with him) while he asked me questions, I was truly intrigued. And grateful. At the very least, my brain was yet again given the chance to function for once.

And most of all, despite the slight dampening in the end to a great day, with my patient deteriorating rapidly in the afternoon and going into Septic Shock, at the very least, I was back in touch with my long-lost self again. I was reminded again that I had compassion as a healthcare provider, and a human being. That I was doing Medicine for all the right reasons as much as I had doubted my resilience greatly from time to time. And most of all, that there was no way in hell I would trade all the lack of seeing sunlight, trekking more than an hour to and from the hospital, and pulling my hair out due to the fact that none of my time would really be my own in the future. Because at the end of the day, the message was clear....

There's really no other place I would rather be.

A is for Airway....and Anaesthetics

I had had several apprehensions before starting Anaesthetics....and I had experienced EVEN more doubts prior to this when I had heard more than one individual proclaim their love for the specialty.

Perhaps it is true when they say pleasant surprises happen when you are least expecting it. Because my first week on the placement so far has been anything but unpleasant. Fair enough, I did come across a fair bit of grilling on my very first day and very first theatre session, but the amount that I took away from it surprised even myself.

And, taking into account the fact that I was still pretty much riding on my wave of vacation fever when I started last week, I had to say that the patience and effort that these wonderful beings poured into helping me grasp the core points around the topic was definitely much appreciated. At the end of last Friday, I had reverted from a Cardio Fangirl to an Anaesthetist Wannabe. Pretty much sold. No further persuasions required.

Okay, I kid. The door is pretty much still open to me, and at the moment, the anchoring heuristic in me still sides the matters of the heart (pun intended) strongly. But it was moments like last Thursday where Lynn and I had had a very productive afternoon session brushing up on our Gen Med knowledge and our systematic approach (or maybe lack of) in handling emergent situations, that struck a significant chord in me and made me realise.....that moments like these...moment like these are what drove me to endure the hours of trawling the hospital, of being ignored or chastised as liked, of tearing hair out prior to exams.....and of potential identity crisis when work commences....and that at the end of the day, there is nothing else but this that I could imagine myself possibly doing.

I will miss Anaesthetics when it is all over. And maybe in another 3 weeks or so, I will have reverted back to the broken, bitter, ill-tempered med student scurrying around A&E when you next check this space.

But for the moment, in customary ABCDE approach, let me just say.

A is for:

- Airway

- Anaesthetics

and - Alyssa being strangely happy for the first time in ages.

Almost There

4th Year done and dusted.

Officially one step closer to achieving my Cardiothoracic dream. Well, of course before that comes job applications and Final Year and FINALS.

KL-bound 15th Aug - 20th Aug.

HELLLOOOO SUMMER!!!!

Anchoring Heuristic

I thought this weekend would never come.

The end of this past week was eventful for me. For one, I finally managed to complete my last Mini-Cex with a Consultant, which I had been having near nervous breakdowns each end of the week about - which would account to about 4 in total - because it was THAT difficult for me to get hold of a Consultant who was willing to watch me examine someone and stick to his word at that.

Hence I had horrendously bad moods most Thursdays in Guildford, because I was going home to London for the weekend with a failure, YET again. Which might have somehow contributed to the fact that I only associated it with negative feelings.

And eventually, it was only natural to hate Paeds.

Perhaps hate is too strong a word. Maybe STRONGLY dislike.

And then on Wednesday when I got my final CEX signed off, I started reflecting and realised, retrospectively, that perhaps.....perhaps it was not Paediatrics per se, but ME after all.

The fact that I had started off thinking that I would not fare well with kids, and my mounting frustration with not being able to get my final CEX done, had turned into an anchoring heuristic. And as we all know, the mind is larger than life. It plays tricks. And I am possibly a master of mind games - being able to continually trick myself into believing something or the other just because I wanted to.

I have plodded millions of steps along this path of life, in hopes of achieving my lifelong dream of becoming this professional provider of healthcare and medicine, and there are many times such as these that when given the chance to pause and ponder, I wonder if I will ever be cut out to be that cool-as-cucumber doctor that I have admired so much, or if I ever do - which field I would be truly passionate about...for a lifetime.

I have anchored myself into thinking I love Cardiology, so much so that I have omitted the fact that it takes alot more to be a Cardio God than just a large-eyed Med Student who spends more time daydreaming than improving knowledge about Paediatric Cardiology, for instance.

At the end of the day, we shall see which path leads me to whichever destination....in the hope that I do get somewhere in terms of my career. And for the moment, anchoring heuristics are possibly more unhealthy than they might make out to be. Or perhaps, it is just that in my efforts to build a stronger personality, I have incorporated some sort of bullheadedness into me as well.

Whoever said things got easier the faster you grew up? Lol.

Indomitable

When I was younger, I had always prided myself on my steadfastness and my dead resolution to achieve whatever I wanted.

I had a whiteboard and marker where I wrote down potential marks to aim for before every examination in school. And then I would make sure that I topped them all without fail.

This week, I have felt my energy faltering as every single day goes by. It is a dilemma really, between wanting the weekend to come quickly and wishing that it would not do so because I am running out of time to complete my Work Based Assessments. It seems strange that the smallest things can set me off, and today I just reached my maximal threshold. I am dead tired, mentally, from the amount of information I have yet to ingest in this Paediatrics attachment, and how my mind cannot seem to flip easily from dealing with as normal a condition as a respiratory infection in an adult, to dealing with one in a kid.

It is one thing to just continuously say that little children are not my thing, and I would still prefer to manage adults as my patients rather than kids, but at this point I don't think I have a choice of sub-specialising as a student, and I hate it when I underperform by my own standards - although I should have probably become used to that by now being the most mediocre medical student amidst a sea of brilliant others.

But it is just not as easy anymore to excel in my medicine as to achieve 100% in that Math exam.

To be fair, it might just be my sudden dip in mood and hormonal imbalance that is bringing about these swings in emotion.

But it just makes me wonder time and time again if I actually possess the willpower and strength to go as far as I have aspired to be through this lengthy journey of doctoring. Not even to be that world class surgeon in my dreams, but just to get med school over and done with and survive being a junior doctor.

I am not even sure that I have sufficiently transitioned from being a good student who had pretty decent grades in High School into a medical student with the enthusiasm and potential to learning doctoring skills, lest even a junior doctor who can complete the smooth transition between just taking a stab at the right diagnosis to making proper management plans.

It is strange how at most times, I feel that I am able to put on the strongest front just to make sure nothing can bother me in the slightest way, yet there are times like these that make me wonder aloud, when the last time was that I actually felt truly happy and satisfied with my life itself.

But the only way to go now is just to put one foot in front of the other and move forward. And hang on to this new ethos of mine:

'The world breaks everyone, and afterwards, some are strong at the broken places.'

- Ernest Hemingway

And just be....indomitable, as such. After all, whatever doesn't kill you....

Right?

This Mind

I think I have a brilliant memory.....

And before you think I am utterly full of myself, let me finish my sentence.

I think I have a brilliant memory.......

For stupid, non-medicine-related things that happened up to 5 or 6 years ago.

Like how I remembered this one-time favourite quote of mine that Meredith recited in Season 2 of Greys Anatomy some time back.

"But Derek, I love you. In a really really big pretend to like your taste in music, let you eat the last piece of cheese cake, hold a radio over my head outside your window, unfortunate way that makes me hate you love you."

With some help from Google, I thought I would stick these exact words here so that one day, when my memory for even these things fail me, I will have this site to look back on and laugh at myself.

Because with my failing stamina and my increasingly tired eyes and my lack of ability to even retain any bit of Medical Info I have weakly attempted to digest (if any at all), I might as well take up a full time job as a professional TV Addict and kiss my vague dream of CT Surgery good-bye.

Tired, and possibly incoherent.

Ah well. Tomorrow is another day.

Neurologically Intact

Strange, how much we take these words for granted sometimes. How easy it is for us to forget the fact that the brain, with is complex anatomy and mechanisms, could literally make or break us.

The past week, the words 'Neurologically Intact' were passed back and forth so casually that it drove home again, how much I take my cognition and well-being for granted at times.

I had been truly pessimistic about the neurorehabilitation experience at the Wolfson before this week began, moaning about it to anyone who would listen about how this was a huge waste of my sleeping time and effort, and that anyone who knew me would know that I have little patience or empathy when it comes to the word 'rehabilitation'. Horrible as it might seem, the lengthy MDT Meetings in Oncology and Geriatrics had bored me to tears, and I was positive that this would do the same.

Strangely enough, it is the things you have had a mindset about hating, that turns around and never ceases to amaze you.

L and I were lucky to have a structured timetable which enabled us to cover all the disciplines involved in Rehabilitation Medicine, and apart from the session with the Psychologist that almost brought me into a stupor, everything managed to change my mind about associating a Multidisciplinary Environment with a couple of zzzzz's, to realising how INTER-disciplinary all the people there were at working towards those goals.

GOALS. Another word that was the bane of my life that week.

From the Long Term Goal of being able to walk out of the Wolfson, to Short Term Goals of being able to perform independent transfers (from wheelchair to bed, for example), I started piecing everything together and saw how important all these assessments and GOALS were in achieving a successful rehabilitation experience. I was genuinely amazed at the Goal Planning Meeting where each team (SALT, Physio, OT, Nursing) came together to give their input on the steps that had been carried out so far during the patient's rehabilitation process, the progress achieved so far, and any tweaks to the programme in the near future to achieve better efficacy.

I loved how the patient's Physical and Cognitive well-being was taken equally into account and fended for by different members of the team, i.e. Physio for Mobility and Transferring, and SLT/OT for ADL's and Cognitive Skills. And to top it off, my experience in Spasticity Clinic was equally rewarding, despite the patient taking more than an hour because his bones were so deformed and the anatomy so messed up that it had almost been impossible for the EMG to detect actively functioning muscle.

And most of all, I discovered once again that I DO have compassion after all. Deep inside. I had been wondering all year, if my enthusiasm had diminished along with my compassion for patients, not just in terms of managing a condition but also caring and empathising. But there could not have been a sadder story I had come across, than a 38-year-old who previously, was a Highly Functioning individual of the society, only to encounter a horrifying road race bicycle accident and be reduced to an individual in a wheelchair with Post Traumatic Amnesia, a lack of Cognitive Skills, apraxia and to top that off, 3 kids under the age of 4 years.

Or that 25-year-old who had ataxia, a huge lack of insight into his cognitive impairment, and no where to go after his discharge from the Wolfson because his mother refused to take him back, stating that he had changed horribly and she could not take any of this. Tragic as this was, it made me so grateful that my family would never do that to me in any case (TOUCH WOOD), and it made me incredibly sad to realise that someone could be reduced from having everything to literally being homeless in the blink of an eye.

I started off Neurology thinking that I would hate this rotation.

I don't. The people are weird, my Neuro foundation isn't brilliant, and even though my Neurorehabilitation experience has not turned out horrendous, I would still not list it as a first choice of career.

But as with all other things in life I possess at the moment, instead of dwelling on the past, the bad, the ugly and the grey areas, I will wake up every morning being thankful that I am neurologically intact.

Ortho UGHHHH

Sometimes I feel like I started off this journey with an entirely sure goal of the level of success I wanted to achieve and the kind of Doctor I would want to turn out to be.

Somewhere along this road, I realised it is one thing to have dreams, and another thing to be able to achieve them.

I remember a time in 2nd year when I would be nailing all the Musculoskeletal stuff and scoring near perfect marks in my Clinical Examinations in the OSCE's. Yesterday, in Orthopaedic Clinic, I realised I had never felt more incompetent in my life. So much so that I was sure the SpR was mentally killing me, or himself, for having had to bear with such a lousy student for the entire morning.

But I was glad I made myself go to that Clinic, in spite of my huge distaste for Orthopaedics, and even though I had already been done on Wednesday with everything. You gotta love what you hate eh?

Might even make myself go to the Orthopaedic Conference in a couple of weeks. We'll see.

Buck Up, Shing. You're spiralling to depths that you don't even realise yourself. And now you don't have SAD to blame it for.

One of Those Days

Today is one of those days. A little bit of the weather and not seeing the sun the entire day, plus a cauldron of unspoken emotions deep within and I guess, just the dire routine of going to Epsom - although ironically today was one of the days that I probably accomplished more.

Got my procedure signed off, got the general sign off from the attachment.

What else more?

Today should be a happy day.

But instead I'm feeling completely out of it.

Yes, I could go on about how Med School is tough, how my level of enthusiasm fluctuates from time to time, how I should have been pleased today that I successfully described and recognised an SVT from an ECG in A&E (woots Cardio), or how I actually got around to doing some hands-on stuff in theatre on Monday. But sometimes it's not really about Med School in general.

It's just me. And today is one of those days that I would like to just curl up in a ball and disappear.

Joke of the Day

Sometimes I think God works in mysterious ways :)

I have been having horrible bouts of Seasonal Affective Disorder (SAD), and although retail therapy did help slightly, this couldn't have come at a more suitable moment to brighten up my day......with laughter.

Just to recap, last week I had a mock OSCE which started off the week in the WORST possible way. Firstly because I had been horribly ill over the weekend and secondly because I was STILL ill when I went for it and was not prepared at all. And oh, did I forget the last reason? Because we were doing it with some people who were on their Paeds placement and did I mention that I know NOTHING about Paeds? The Paediatric examination station didn't help. I had never done one before and the kid would not stay still / was eating crisps!! I wanted to kill him at the end of it. And yes, I mean it literally.

I left the OSCE feeling horrible. Sure that I had flunked it grandly. Then SURPRISE there was a written MCQ paper to follow. Even better. True/False questions. Just my cup of tea. MORE Paeds questions....and to be fair, Medicine and Surgery as well. But just as terrible.

Today, I got the emailed results, and was expecting to see multiple FAILS all over the Word Document.

To my immense surprise, I:

1) Passed my written MCQ! ZOMG there must be a Cerulean tinge to the moon right now! Amidst all those Paeds questions and me hacking my lungs out, I managed to get a pretty decent pass.

2) Not only passed my OSCE too, but got this comment for my Paeds examination station:

'Demonstrated a perfect Paediatric examination. A natural Paediatrician in the making.'

HAHAHAHAHAHAHAHAH. This sparked a good amount of uncontrollable laughter and I am still amused!

The whole world knows that I am not fond of Paeds. Or kids in general. I have not done it yet, and I even know that I will already hate it. Plus, I was almost in exasperation with the crisp-eating and a super sloppy respiratory examination. What can I say: the examiner must have been blind!

But works out well for me. Brightened up my day indeed!

HAHAHAAHA. What d'u think? Perhaps I should add Paediatrics to my (super short and super biased) list of career choices.

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.

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

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.

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.

You know Apple is taking over the world when....

......this conversation happens between you and your consultant.

Me: Yeah, I've just looked up (this drug) on Pocket Prescriber.

DB: Isn't there an app for that sort of thing?

Me: Yes, probably, but I don't use an iPhone.

DB: Oh, right.

Me: (In my head) Pfftttt not EVERYTHING in life is about iPhones, iMacs or iPads, y'know.

Now I refuse to succumb EVEN more!!!