Monthly Archives: December 2009

The big difference

This is my second elective i have chosen to voluntarily undertake during my vacation because i would sincerely like to learn more, know more, and be less stupid. This is also my second surgical elective. Unfortunately, both times, i find myself bored out of mind, wondering whether i am wasting my time, and for the umpteenth time, questioned my wisdom in entering Medicine as a profession in the very first place.

Really, all i do is shadow the doctors on their ward rounds, try to think through the patients’ management plans, and stand in the operating theatres trying to get a precious glimpse of blood or two. I could stand in an eight hour operation, only for me to see the organs once or twice. And usually, apart from the very obvious, i am quite clueless as to what i am looking at. I really wonder how people learn on their electives, and why some gush about how much knowledge and experience they have garnered, whereas i seem to be languishing behind; and in fact, as each miserable day of my elective passes by, i start detesting Medicine more and more.

Today, a Registra who had been on sick leave came back. During the ward rounds, he started asking us questions and teaching us stuff. After the rounds, he actually took the time to conduct an informal teaching session. I was aghast. For once, i had my questions answered and i was really learning something. I realized that perhaps i am not as clueless as i thought i am, and i did feel a sense of satisfaction with myself when i could get the answers right. This made me want to strive harder, and most importantly, i started to like what i am doing.

Before him, when i had a question and i tried asking the other Registra, she said quite bluntly, “Read it up on your own.” I got the hint straight off – Leave me alone. I did. And i was very unhappy.

But this new Registra is just fantastic. I saw the other medical student brightened up immediately too. Previously, he was like me, tagging solemnly along with the team, just trying to stay out of their ways. I learnt more stuff in an hour today than in my whole three weeks combined. Unfortunately, my elective ends today. (But the world is not coming to a grinding screeching halt because i approached this new Registra and obtained enthusiastic permission for me to come in an extra three days next week to learn till the day i am jetting back to the Land of Fish and Chips).

I have been brooding about this sudden turn of events. I always attributed my unfulfilling electives to myself – perhaps i was meant to be more proactive (although i am not sure how much more proactive i can be if questions are frowned upon and i am expected to be silent), perhaps i was really not that interested in Medicine in the first place, perhaps i am supposed to know all these but i must have been slacking off because i don’t (again not sure how i am slacking off). These severely unhappy feelings were making me pursue a lot of other extra-curricular activities (not that i am complaining because these activities do provide a happy avenue for me to vent my misery) which then reduces the amount of time i have to study, which then further exacerbates my thinking because i start thinking I am obviously not studying hard enough if i can devote so much time to other things. Hah.

I thought about it, is teaching really such a drain of resources? I honestly do not think so. Teaching is certainly a two way street – when you teach, someone else learns and this person will be a future doctor whose skills you have a part in molding. When you teach, you certainly learn stuff on your own – you strengthen the knowledge base you already have, you read up so you can teach better and therefore effectively widening your knowledge base, and you gain very strong support from your colleagues which in turn gives you a better reputation, and i think you naturally treat your patients better because there is an unconscious need to be a role model. The more i ponder over this issue, the more i think it is really short sighted not to teach just because you can’t be bothered.

Also telling a student to read up has two implications. Firstly, you are implying the student is lazy, which to someone like me, is especially damning because i take this seriously, and it makes me very discouraged, when obviously that’s not the case. This negative feedback only serves to fester the doubts in my head about Medicine, and i start to forget that i like what i am doing. Secondly, if all i need is to read up, then tell me, why the fuck should i still attend any tutorials, lectures and clinical sessions? After all i can always read it up. Clearly there must be some sort of benefit for students to have their questions answered on the spot; it just adds a variety to the different media we can learn. Medicine is such a vast subject, we really should try to sponge off any knowledge we can glean in any way. And i am being completely reasonable about the questions – it is not as if i’m asking questions at rapid fire speed. I am merely asking questions that i don’t encounter in my readings, and that are usually seen in reality.

So yes, i am angry. Angry that i have been so unfortunate to have met not one but two bloody electives where people cannot be bothered to teach, whereas i know of friends who seem to strike gold anywhere they go. It pisses me off because my efforts are wasted and under-appreciated. It makes me very apprehensive about my third elective (and this time it is an official one) that i am due to start in a week and half. What if i don’t get taught anything? Honestly, in these situations i really learn more just by reading on my own, yet i am forced to plaster a sick smile on my face and turn up at the hospital and play the part of an invisible ghost, or risk a bad reference.

Well at least something is cleared now. It isn’t me. It is the part of those blasted doctors who refuse part of their responsibilities. That’s right, if you are a doctor, a part of your responsibility is to teach. You will never have gotten to where you are if someone had not taken the time to educate you.

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Blackberry

I bought a BlackBerry Bold 9700 yesterday. My family was aghast i did not want an iPhone instead. But after they looked at the specs i think they understood that the BlackBerry was far more superior.  And anyway it doesn’t matter since my parents bought two iPhones, apparently one for each of them? One in black and one in white. Unbelievable. Even they are falling for the hype. My dad does not even know how to use the internet! There is no way i will be caught dead carrying the same phone as my parents’ generation, just like how i left Facebook after my twelve year old cousin added me, followed by my aunt and then my mum. Erm…thanks but no thanks.

I do not like the iPhone. I do not like the touchscreen, nor do i like the way it reminds me of my iPod. I have an iPod Touch – it drives me mad. So much so, i hardly listen to music on the go these days.

Anyway i am kicking myself for not being a BlackBerry convert way earlier. They have a very cool trackpad that is the equivalent of the the mousepad on a laptop. I am loving it. Loving the sleekness and the design and the layout.

My only question? Why can’t i save any of my contacts or photos directly onto the memory card?

Animal shelter

I went to the dog shelter just now. Actually, it was more like i was heading towards the pet megamart when i saw at least forty dogs milling together in a large compound. There was a young girl cleaning up the poo. On a hunch, i asked if it was an animal shelter. I was right.

I stared at the dogs milling together. Dogs of all sizes. In the Land of Fish and Chips, dogs were not allowed to mix both for the safety of the canines and the staff. Here this was the best they could do. Amazingly the dogs did not fight. The more dominant ones growled and the rest would scoot.

I entered the compound, and it seems, much to the surprise of the people operating it. I guess i wasn’t exactly dressed for the occasion – in new jeans and a clean t-shirt? One thing is for sure, the dogs are very well-socialized with other canines but they were very shy when it came to human interactions.

My sense of smell has been stuffed thanks to my current cold (i have to say this upper respiratory tract infection i am getting is quite severe. I have been coughing violently. I would have thought this may be whooping cough except i have been vaccinated against it earlier this year. Last night, i did ponder about the chances of me getting pneumonia), so i could not smell the odour. I can tell you one thing for sure. The people who run the animal shelter know what they are in for. No one in Potato Land will be adopting any of the dogs. Not when these dogs are mongrels, large and seemingly ugly. It doesn’t matter that these dogs look up at you in earnest and strict loyalty, or observe you with intelligent curiosity. Potato Landers are very very very materialistic. And it does not help that there is a pet shop selling puppies at every corner. This is the sad truth of Life.

I really want to help rectify the situation but i think it is beyond me.

Abscess

We were called down to the Emergency Department because a patient required a surgical consult. Before we stepped into the cubicle, the smell hit us. I was a greenhorn so i did not think much about it. But the Registra immediately balked and choked out that what we were going to see would probably be bad since we can smell it before even locating the source.

A large man laid sprawled on the bed. He was so massive he could barely move. I asked him where the wound was but he did not respond. We wondered whether he was mentally fit. We hunted for the wound but it was not a difficult task. The copious discharge was oozing and staining his t-shirt. We examined the wound. It was a suspected case of necrotizing fasciitis (think: flesh eating bacteria). I palpated the wound, the surrounding skin was stiff as cardboard. It was not even painful, in fact the patient, to our mortification, was trying to scratch his wound because it was itching.

The Registra proceeded to examine the wound himself. To my horror, he did not don on any gloves. He used his bare fingers to squeeze the wound to check for any discharge. The wound made a sickly squelching noise as he did that and some highly purulent and pungent liquid oozed out. Obviously some of the discharge accidentally got onto the doctor’s finger. He could not find any tissue paper in the immediate vicinity and was in no mood to go hunting for one, so he held out his fingers just like one would do after eating oily fried chicken. Then an intern called out to him, and he walked over to the computer terminal where he promptly forgot about his contaminated fingers and proceeded to use the computer mouse. My eyes bulged when i saw that. I could not stop my squeamishness. The most disturbing thing is that i am starting to pick up the terrible habit. Because we are always in a rush, and for some reason, this blasted hospital has a tendency to hide their boxes of gloves; i am forced to do hernia examinations with bare hands. It is not a nice feeling having to touch someone else’s pubic hair without gloves. I have to constantly brush aside the voice in my head that reprimands me for all the infections i am exposing myself to.

Anyway if we had our way we would have immediately sent the patient to the operating theatre to debride the wound. Unfortunately, the patient came with a welcome package of several life-threatening medical conditions, including a very bad heart despite a pacemaker and uncontrolled diabetes. We had to optimize his condition before we could perform surgery. This patient was a disaster waiting to happen; he could very well die on the operating theatre. And he is under fifty years old by the way.

Then the Registra barked an order to the intern. Bloods needed to be taken. I did not understand why the intern was in such a fluster. He prepared the needle and tugged at the patient’s arm, causing the patient to shriek in pain not once but quite a few times. And each time he never apologized nor explained to the patient what he was doing. Patients in Potato Land do not complain either. Doctors have god-like status (though the nurses and hell even the ward clerks think they are the ones who should be worshiped. *Rolls eyes in distaste*). The intern tried to draw blood from the infected arm. He failed on the first try, and using the same needle, he pricked the patient a second time. One thing about taking bloods, if you fail on the first attempt, you should get a new sterilized needle to try a second time, otherwise you will be facilitating the spread of infection. The intern once again failed to hit pay dirt and he progressed down to the back of the hand where he stabbed the patient a third time, using the same needle. And then a fourth where he finally literally drew blood. I was appalled. You know if this patient really has necrotizing fasciitis and it happened to spread to the first puncture site and the intern did not notice it…well then the intern just assisted our resident flesh-devouring bacteria in its quest for territory by facilitating its spread down to the hand.

Sometimes i am bewildered as to how people can leave their wounds to such a disastrous state before seeking medical attention. Is it the smell that finally indicates it is time to see a doctor? My goodness.

Revelation

So over the past few days, i attended a few family gatherings. Christmas was passed rather uneventfully – i was and still am down with a severe bout of cold that has prevented me from going to the hospital the past two days. I am a bit put out by that because my elective is almost drawing to an end, and i don’t feel like i am getting as much out of it as i should. I think i am going to have to put it a few more on call nights next week just to replace those days i have lost.

When i was in the Land of Fish and Chips, there was a year i spent Christmas with a band of really close friends, and then there was a year where i spent Christmas completely alone, save for my dog. All festive seasons no longer hold any cheer for me; i just feel that they are like any normal days, really not much of a big deal. Part of me did wonder whether i was becoming a little too cynical, a little too lonesome. Then when i spent Christmas with my extended family a few days ago, i realized to my immense surprise that it was really not much of a difference. I was really looking forward to having lively debates/discussions with my relatives, but i discovered (to be honest i was not surprised) that none of my relatives were the type to share their opinions. Rather they fell into two categories – one group that would only listen and nod politely, and the other group who would narrate and not expect people to challenge their opinions.

In the end i spent most of the night watching a rented DVD with a few of my other cousins. I felt very lonely and i was incredibly bored. I wanted to go home, and just curl up on my couch with my novel, or watch a couple of my own DVDs. I missed my dog. This was the start of a gradual understanding that my life is no longer in Potato Land. My life is now back in the Land of Fish and Chips. It reiterated the point that i have known for a long time now – that i can be surrounded by loads of people but still feel lonely. I do not need a lot of people with me, i just need the things most precious to me to be close to me. And because of this, i understood also why festive seasons no longer feel extra joyous. It’s because i always ensure that the things i hold most dear to me are with me every day, so every day is a day worth living. I know this sounds very clique, but you have no idea how a lot of mere acquaintances are perplexed by my principles.

It has also been a few years since i returned back to my homeland. I came back this time round with an agenda. I wanted to know if there was anything worth coming back for. I wanted to check out the job prospects, and i wanted to know just exactly how my extended family matters to me. On the professional side, i have been dumbfounded with my numerous observations. I came to one solid conclusion – if i want to become a better doctor, i need to stay in the Land of Fish and Chips.

On the familial side of things, last night, i discovered exactly how deep alcoholism runs in my extended family. Hand in hand with alcoholism, i discovered with great sadness that violence came along, and it was always the wives and the mothers who bear the brunt of it. A discussion with a cousin turned sour. I recognized the switch and saw in his eyes the explosive rage my cousin launched into. It culminated with vulgarities and his mother had to drag him home. We are talking about a twenty-four year old man by the way. I discovered that my older cousin gets bashed by her drunken husband, but no one does anything. I learnt about the physical abuse another cousin meted out to a younger one, and it was only discovered when my aunt noticed the bruises. My aunt never told my uncle or her son (my other cousin) because the culprit would be severely hurt. I observed how rude some of my younger cousins behaved because they were emulating the behaviour of their abusive father and their mother was helpless. I found out how an uncle was openly sleeping with another woman, and how my aunt could still pretend that everything was all right, and the cheek this uncle had to still turn up at our gatherings with his head held high. I learnt of a cousin diagnosed with Schizophrenia but whose mother decided to hide him at home and not let him out because of the stigma. I was horrified. It seemed that part of the family’s dirty laundry tumbled out last night, on Christmas day.

Part of the problem is the culture, where women are still submissive. Another part of the reason i feel is with the exception of my family, none of my other cousins had the privilege to be educated overseas. They were not exposed to a variety of people or situations. They performed well academically and were thus treated like demi-gods. No one has ever shown them that Life is more than the box they have enclosed themselves in. A cousin who was losing a debate we were engaged in demanded that i should never question others and only myself, and he ended up accusing me of being an arrogant intellect. I was really astounded and stunned. Men are still treated with an elevated status. My few years spent mingling with the Western educated women in the Land of Fish and Chips had somehow made me think that i had over-exaggerated the imbalance of gender authority in my head. But barely two weeks back home, i understood that the imbalance is still very much larger than life.

I cannot stay here and watch helplessly as i see the men bully their women. My hands are tied. I would have called the Police in a jiffy, and have these fools sit their arses in cold cells. I would have asked the women to have the courage to divorce their husbands. But i know this is not how it works. I can kick up a major fuss but if the women are not ready to stand up for themselves, whatever i do will only exacerbate the problems and i will be branded the instigator of the family. Here in Potato Land, women are still expected to get married and tend to their families. I am considered an anomaly, though no one, man nor woman dared tell me that in my face.

I know now that there is nothing holding me back in Potato Land. I have done my part, and looked for any responsibilities that i may have. There aren’t any. I know now that i can move off without feeling any sense of guilt. Potato Land is a toxic environment. If i want to be a better person, then i need to leave this place. I know on a deeply personal level, listening and witnessing all these accounts have affected me. I am afraid of forming long standing relationships – i can’t bring myself to trust a man. I know this is a terrible mentality but i can’t help the fear. All the men closest to me, those who should be role models, are dreadful people. So i know i must leave. Leave this place, leave the people who do not want to better themselves, and find a path for myself.

This is it.

Feeling stupid

Feeling stupid is part of the life of being a medical student. But i am experiencing it more acutely here in Potato Land. I am not quite sure why. Perhaps i really should put in more studying (how?!) or it could be the difference in the way medicine is practiced. It is causing me marked distress, yet i can’t seem to pull myself out of this sluggish hole to read a textbook. I do get in a few pages now and then, but certainly not the kind of hours i will dedicate like those before my exams. I know it is my holidays and i should take a breather. I am. I am pursuing my reading appetite voraciously (and i am a tad crestfallen that i am not able to just spend my days lazing in bed reading the numerous novels i have bought from Borders a few days ago. I probably have to ship most of them back to the Land of Fish and Chips, which then pose another problem because my bookshelf back home is sagging under the weight of my novels. I have to get another bookshelf…soon). But i am perpetually exhausted. After my 12 hour days in the hospital, i catch up with old friends in the nights. By the time i get home, i literally collapse on my bed. Before my head hits the pillow, i am fast asleep. The cycle continues. How do i break out of this? I am not sure.

Changed tactics

I sprained my hip or something of the equivalent. I am tolerating pains that are radiating down to my groin. I went for my second Judo training yesterday (in five years! Sorry, i needed to reiterate that point to myself), got thrown and landed badly. The minute i hit the ground, felt my pelvis strained under the impact, bounced off the mats, and the pain came; i knew it was all over.

It was then i had an epiphany. Honestly, am i out of my mind? I just turned 24; did i really think i could be hauled around carelessly on the mats and still get away without any injuries? What has gotten into me?

I resolved to quit Judo on the spot. No more of this madness. I did think about it when i got home. I was a bit disappointed. During the remainder of the training session, i stood to one side, quietly observing the rest of the players sparring with one another. I wanted to join a bout, but i knew it was suicide. My priority ain’t Judo anymore. I have a surgical elective to commit to. I cannot possibly turn up at the hospital, hurrying after the surgeons as they go through one surgery after another with an injured lower limb. And i have another elective in a different country to consider too. The stakes are too high. Besides, i know i will be pummeled because i am not able to move my left hip, pelvis and leg without wincing in pain.

However, after talking to a friend and doing more thinking (and googling), i have come up with an alternative plan. Judo has two components – the throwing and the grappling. I have always been bad at the throwing part because i detest falling. But i know i am much better at groundwork, the grappling part. In my Judo days, my former coach did introduce and encourage me to take up Brazilian Jiujitsu (BJJ) – a martial arts system that evolved solely on groundwork. I never took his advice seriously, especially after a friend commented that it looked like a variation of the Kama Sutra. And i must also admit that i was not that receptive to the idea of having to fight with males on the ground, especially since only men seemed to train in such martial arts.

Can you see where this is leading to?

Yes you can. Aha.

I found a BJJ academy near the next hospital i am heading to for my trauma elective. And one near my home back in the Land of Fish and Chips. I hope this turns out well.

And yes i will still be going for the Judo training till the end of the year, but i am going to cunningly step out of the throwing components.

I also know now how it feels like to have osteoarthritis of the hip. Maybe i can be more empathetic in the future.