Monthly Archives: April 2010

Random photo of the day

A row of chickens.

I went out to have some Hong Kong cuisine for dinner with a friend. We had a seat right in front of the kitchen; could not resist taking a shot of the entire line of dead carcasses hanging in front of this lady. One of this chicken was probably used to whip up my favourite dish of spicy chicken ribs. Yum.

We went for ice-cream after that. There is this particular outlet that sells Bubblegum ice-cream, nowhere else. I love Bubblegum ice-cream. ALL my friends think i am mad for liking ice-cream that’s blue in colour. And apparently they think it tastes like detergent. Unbelievable. This coming from people who love brinjal. Yucks.

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Pregnant women

Today i attended my first antenatal clinic. It was good. I got to perform Leopold maneuvers.

Leopold Maneuvers

I have never touched a pregnant abdomen before and i was glad i was not too nervous about it. (I think i was more freaked out about taking blood pressures, because i have not taken blood pressures in 6 months and i was confusing myself over which way i should place the damn cuff. It got sorted out eventually. I need to stop psyching myself out. Confidence is what i need.) Anyway, back to pregnant bellies. I had to palpate for the top part of the uterus, something which i need to work on more. I can’t tell the difference, but i have got a couple more weeks to figure that out. I just need to palpate more pregnant abdomens to get a “feel” of what normal is like. Then i had to palpate for the fetus’s head near the pubic symphysis to see if the fetus was in the correct position for delivery (head down would be preferable, sometimes the fetus ends up wanting to come out buttocks first – known also as a breech delivery). That was even more challenging. So far in all my palpation of abdomens, all i ever needed to do was to feel for lumps and characterize it. Now i am supposed to take it one step further, to try to delineate whether the lump i was feeling is a head, and whether it has engaged into the pelvis (descend far enough into the pelvis to know that delivery is imminent).

Then i got to seek to out the baby’s heartbeat using a handheld device (what is it called? I was told by friends it was a Doppler, but how can it be a Doppler if there are no sonograms, let alone coloured sonograms for us to see directions of bloodflow??). And i thought heart murmurs were challenging. This was even worse. I had to differentiate between the mother’s heart sounds, the placenta noises and finally the fetal’s heartbeat. It was all a bit mad. I could not get any fetal sounds in the first two patients but after observing and hurriedly picking up the subtle tricks and techniques the consultant was using; i got the hang of it. Now i just want to feel more comfortable doing the whole process.

Really love the outpatient clinic. Actually it really brought the point home today as to how much i love physical signs. I really love being able to palpate for masses, and looking for hard clinical signs on physical examinations. This is why i like surgery so much – it is a specialty built on physical signs. I mean, if you don’t have convincing physical signs, you would not be sending the patient into the operating theatre to be cut open in a jiffy right? That’s why surgeons are so good at picking up such subtle signs. It is an Art, an Art that i would really like to learn.

Anatomy

I went into theatre with a friend today to watch a surgery performed for endometriosis. The patient was really young, young as in, only a year older than both of us. It was kind of weird. It is like seeing your friend naked on the table. It was probably awkward for the patient too because we were hassled out of the OR (operating room) and only allowed back in when the patient was unconscious. But the weirdness just lasted a few seconds before it was all business.

I have to say that anatomy is not a very strong subject of mine, but anatomy of the genitals got to take the cake. I don’t know why, but i can never get my head around it. Maybe it is because the real thing never looks like the one drawn in textbooks. You know, it took me two years before i finally figured out that there are two kinds of penises – a circumcised one and an uncircumcised one. In my first year of medical school, i was perpetually confused by textbook diagrams. Not one textbook had the courtesy to explain whether they were drawing a circumcised or an uncircumcised penis; i just shoved my confusion under the rug. Don’t know how i finally figured it out, but i did. It was also fairly recently did i discover the urethra is not in the clitoris. (Don’t laugh, i bet most of you (friends reading this) did not know that too because we are so damn conservative.)

Anyway, so this patient’s vagina was exposed. I tried to go through the anatomy but i was utterly confused. Clearly i can identify the major parts, but the vagina is so confusing. (No wonder guys can get it in the wrong hole, this fact, i was told.) The patient looked like she had an anterior vagina wall prolapse yet she’s so young; it really is impossible. So i prodded my friend, who is male by the way.

“Hey dude, can you just tell me what the hell is that?” i nodded towards the vagina.

“I don’t know, and i don’t want to look,” was his obstinate reply.

“What do you mean you don’t want to look? We are on our Obstetrics and Gynecology rotation! It is all about vaginas!”

My friend firmly kept his eyes averted. I was exasperated.

“Don’t ask me, i am bad in anatomy,” he muttered.

“Unfortunately, you are the only other person in this room whom i can ask, so i am asking.”

“Why don’t you know this?”

“Because i just don’t!”

Anyway, i finally asked the resident. It was the urethra. (Point to note, it was not today that i discovered the urethra is not in the clitoris; it was some other day a few weeks back when i was reading up on bladder extrophy in children.) This is when i can tell you very clearly that you really got to look at the real thing to get your head around these things. Diagrams just don’t help. I cannot believe the urethra looks so different.

When i was younger, i read a book on true medical encounters, and there was this 50 year old female patient who presented with recurrent urinary tract infections. The doctor had a look and realized this patient’s hymen was still intact. But she’s married and still sexually active. How did that happen? Penetration was occuring via the urethra not the vagina. I could not believe it when i read about it. Today when i saw the urethra, i understood how it could have happened. The urethral’s orifice is larger than i expected, and closer to the vagina than i anticipated. No wonder sometimes one can accidentally catheterize the vagina instead of the urethra.

I prodded my friend and told him to look because we had to be catheterizing female patients soon, so he better get his anatomy right, or rather her anatomy. Also after i saw the patient’s vagina today, i am finally convinced that it is large enough to accommodate childbirth. Which then brings me to my next revelation – no wonder most men and some women are so obsessed with penis size. If the penis is small and the vagina is large, i suppose it is harder to get any traction? Just a few thoughts out loud…

And i am regretting not turning up for BJJ today. I just really dread the no gi training sessions, and the fact that i am not properly taught the beginner techniques before i am thrown onto the mats to fight. But now i feel like a wimp. Amazon is taking too long to ship the book i ordered. Should have just gotten the book at a local bookstore. May have been $20 more expensive but i am wasting my club fees by skipping 2 weeks of training and counting and that’s costing me $60 already. Argh. I am so annoyed with the way i analyze things sometimes.

On a martial arts roll

On a whim, i started searching for theme songs of a few of the other martial arts series i have watched, on YouTube. I could not believe i found them all! Oh my goodness. Man, if these songs are available on iTunes, i would have bought them immediately.

(I have included the English titles these series were debuted under, but whoever who did the translation had it way off…)

书剑恩仇录 (The Book and Sword)

七剑下天山 (The Seven Swords of Mountain Tian)

少年杨家将 (The Young Warriors)

The weekend has been very busy. The week culminated in a small class test where we were forced to memorize definitions and then regurgitate fifty of them in half an hour. I must say that i have not sat down proper to memorize stuff since i was in high school, so the fact that i had to do this in medical school really horrified and disgust me. We had to attempt to remember word for word because our scripts were marked by fellow students. As we all know, students can be the most rigid of markers, any word out of place and you may not get the mark. Anyway, i was really angry. Remembering and understanding the definitions is one matter, committing the exact wording and phrasing to memory is another. I can do the former in a day, but the latter required an extra day of effort; precious time that i could have spent understanding other concepts. After the test i did see the logic in the professor’s insistence in such rudimentary methods, although i wondered if applying them instead of compelling us to regurgitate them would have been a more constructive way of learning.

On Friday it was raining, and i wondered whether soccer training was on. It was – i gained confirmation from one of the senior players. Except that only six of us turned up. The coach was missing and so was the captain. I was aghast, so much for team morale huh? I was bracing myself for another shitty useless training but the other more experienced players were clearly more dedicated. We did a lot of goalkeeping practice so i was really happy. All that helped in my match on the weekend; this time i played the entire match. Although we were thrashed, i was satisfied with my performance. I did not repeat any of my mistakes from the first match and i was proactive in fighting for the ball – that is there were occasions where i collided with the strikers in my desperate efforts to catch the ball. Once, the striker actually kicked my arm; i saw the pointed end of her boot coming and i could do nothing about it. I felt it connected and i honestly thought i fractured my humerus. I just earned myself a bruise, thank God. The second time another striker desperately tried to score but i was in the way, and i felt the impact in my gut. I think my years of martial arts training is paying off in areas i did not foresee; i came off unscathed.

I think we need more training as a team. We had perhaps 15% possession of the ball at best. Most of the match was played in my half of the field. I felt the only reason why i could perform well was because i had so many potshots taken at me that inevitably i had to be catching quite a few right? The converse was also true. On the fifth or sixth attempt by our opponents, i knew the tide will turn against us. It is a matter of probability. The more attempts you make, the sooner or later, one of the balls is going to end up at the back of the net. And it did; a total of five times. I was exhausted leaping around, diving and sacrificing body parts to get to the ball in desperate measures. But it was good fun and i enjoyed myself. Oh i have to add that i earned myself a yellow card in the second minute. I never knew that a goalkeeper could not catch a ball when it is outside the line of the penalty box at the sides? I saw our opponent striker broke free of our defence line and she was racing down the flank. I got to the ball first but since i did not know the rule, i caught the ball instead of kicking it out. The striker looked appalled. My defender looked apologetic, “Honey, you can’t touch the ball if it is out of the line!” Oops. Our coach had an indescribable expression on his face; my team had a good laugh about it in the change room. The referee looked sorry that he had to give me a yellow card.

I think the most significant part of my weekend was when i watched the end of my Chinese martial arts series. It had such a sad ending, i was actually tearing alone on the couch with my dog. What the heck right? Then my housemate came home and i had to pretend to be asleep in case she came to talk to me and hear the tears in my voice. She will probably laugh hysterically at me. I know my other friend was in disbelief when i told her. 少年杨家将 – it is a fantastic show, certainly one of the best i have watched so far, but my god, it is so bloody sad. I am thinking about it and feeling sad so many days later. Unbelievable.

Anyhow, here are the YouTube videos for the introductory and the ending songs respectively. Once i am over my sadness, i am going to find more new martial arts series to watch. Now, i should probably haul ass and get changed to go to the hospital. I may have to go into theatre; i hope i observe something interesting.

The most infamous scenes – the saddest, with an equally heart-breaking song to boot.

Cerebral oedema?

For the past two weeks, i have sort of been suffering from a bout of severe malaise. I am not quite sure what it is, makes me wonder whether i caught any EBVs or CMVs or the other notorious Vs from someone somewhere. I cannot explain this exhaustion. And maybe i am in denial; my body is no longer able to cope with physical exertion as efficiently as i was able to a few years ago. Maybe i have got a mild concussion from the rough tumbling i took in my last BJJ session, or the two soccer ball hits i coped when i was training last week. I don’t know. But i need to rid myself of this severe fatigue. It is disrupting my sleep which is now affecting my concentration during lectures. Fuck. And i have noticed my fuse has grown steadily shorter and my anger more intense. What the heck.

Also today i noticed my soccer boots are wearing out. They are six years old so i suppose it is high time for a new pair. But i am not ready for one. I need more goalkeeping practice but this coach does not seem to have enough control of the team. Too much talk, too much laugh, too much fooling around. And then at the end of the week, we do two hour circuit trainings just before our match. Is this really the right way to be match-ready? I can’t recover in time to be match fit. And i am smashing my left knee doing too many dives. I am frustrated.

Frustration, i have noticed, seems to be a constant companion in my Life.

Obstetrics and gynecology rotation

Today i started on a new rotation – obstetrics and gynaecology. I was told that this rotation was quite slack, as in we would have many days off. That was why i could commit to playing in a soccer team. I should have known better.

Today i checked my timetable and to my horror and disbelief, i literally have a seven day week. I am scheduled to follow the consultant i have been assigned to for clinics on Wednesday and Thursday, and to go into theatre (operating) with her on Tuesdays. And i have tutorials almost every other day. Then i am scheduled for 14 hour shifts on six of the nine weekends of my rotation where i am expected to linger in the birthing suites waiting for pregnant women to give birth. Failure to do so would mean marks get deducted in my overall assessment grade.

I thought medical school had shown me its darkest side. Clearly i was wrong. I don’t know why i keep ending up with such shifts. I was told my Pediatrics rotation (the last rotation) would be quite easygoing too. Again that was not true. I was clocking eight hour shifts whilst some of my friends had two day-weeks. Wtf?

And the other shocking part was, how could they (the people up there) expect us to devote our entire lives to Medicine? Did they not believe in a well-balanced lifestyle??? Now my concern is how am i going to relate this disastrous news to my new teammates. There is no doubt i will have to skip one or two practices, and possible a match. The rest of the time, i can glumly forsee myself rocking up for training, leaving half an hour early to nip home for a shower, before rushing to the hospital to clock a twelve hour night shift.

FUCK. And did i mention that we will not have the freedom to do anything without the blessing of the midwife. In other words, if i want a coffee break, and the midwife does not think so; i can jolly well sit my sorry ass in the birthing suite till the end of the shift. Even if there is no patient. Oh my God.