Monthly Archives: June 2010

Camouflage in the shadows

Wind’s chilly. Been walking the dog in the night, head tucked down, hands in my pockets, trying to stay warm in the blistering cold. The dog, however, seems to be cold-blooded, not minding the sharp bite of the wind one bit. We walked down the dark, familiar and quiet street when i spotted a package on the bonnet of a white car. I could barely make out the silhouette under the weak moonlight. I thought someone had forgotten their stuff on their car, like i did once.

I left a tupperware of cake made by my friend, on the roof of my car once, and drove off. At the junction, this rough-looking woman in her sports car was yelling and gesturing at me. I checked my car’s position, made sure i was in nobody’s way, stared at her, and then ignored her. Man, she was persistent in getting my attention, and i was starting to get increasingly nervous. I know people can be crazy, and i hope i was not going to be someone’s target. My friend who was in the car murmured what the hell was wrong with that woman. Anyway, that woman’s lane progressed and she drove away. Then the car behind started honking at me – this time a genial old man. (Also note how my stereotypes are terrible??) I knew then something was not right. He pointed upwards, so i got out of my car and saw that blasted tupperware, the object of all attention. That kind-hearted lady driver probably thought i was a moron, and rightly so.

Anyway, i stared at the thing on the white car when suddenly something clicked and i realized it was a cat. A beautiful pure white cat. On the bonnet of a white car. I wondered whether it purposely sat on that white car because it was white, so it could be camouflaged, or it was all purely coincidental. I doubt it was coincidental – is it even usual for a house cat to sprawl on the top of a car in the freezing cold??

"I can see you, you can't see me...not!"

I chuckled to myself as i passed it. It crouched even lower. For some reason, my dog did not notice her. Weird. Anyway i took a few steps away before i decided it was a photo opportunity too hard to pass up. I walked back to snap a few shots. The cat tensed up but when she realized neither the dog or i were going to lunge for her, she settled down, completely comfortable with the camera. Unbelievable.

"I am going to ignore you, crazy human."

Now i need to motivate myself to get started with my Obstetrics & Gynaecology revision.

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What was that all about??

First day of exams yesterday really didn’t go too well. It was one of my Pediatrics exams where we had to interview actors that were hired to play worried parents. There were four stations and the only station that went well for me (or at least i felt confident about) was the surgical one. Everything else was a shock. I had two consultants who i had worked with before, invigilating two of my stations – one was the surgeon, the other was a neonatologist, who also happened to be one of my referees for my intern application. I was so embarrassed during that station that i did not dare look at my consultant. The examined topic was so left-wing that i was caught off guard.

Basically i had to explain to a ‘parent’ the rehydration management of her infant who has been diagnosed with mild gastroenteritis and whom the consultant has deemed fit to discharge home. I had NINE minutes to talk about oral feeds, monitoring further complications, if she was able to cope with her child at home if we were to discharge her, follow up with her general practioner in a few days, informing childcare, precautions with her other child and if she wanted a pamplet. All of which i covered in THREE minutes. The remaining six minutes were spent reiterating myself and constantly harrassing the patient  with “Do you have any questions for me?”, “Do you have any questions for me?”, “ARE YOU SURE YOU DON’T HAVE ANY QUESTIONS FOR ME???” Jeez, normally, the actors will try to help us out if we miss something, but this one was like a complete stone wall. Holy shit. I discussed with my friends and we all came to the conclusion that this was a mad station, and they probably have to audit our results since we are all probably going to perform really badly.

The other two stations were as bad. I completely panicked when i was given a urine dipstick to interpret. I have done dipsticks before, but this one was slightly different, and i panicked and completely did not know how to read it. The problem with my examiner was that he just left me to die (and so with the other students in my particular group). However, in other groups, the doctors actually helped the students align the dipstick, or corrected them if they saw the students were struggling. This bloody discrepancy pisses me off, because if i can’t interpret the dipstick, then clearly i will lose marks on the subsequent questions. This is another reason why i detest the institution i am in. Their methods of examining students’ competence differ widely and in their attempt to prevent all of us from doing well, they come out with ridiculous questions that stump us and outsmart themselves making them look like complete klutzes. In that station, there was also an error in the result, which they altered for the afternoon group of students. Unfortunately, i am not sure how they can adjust our scores, since for a lot of students faltered for the subsequent questions when they got confused by the MSU results. Ridiculous.

The last station was just…i don’t know. I did read up on that topic and i did regurgitate everything i read up on. The invigilator was very nice, constantly prompting me, trying to help me get marks. Unfortunately i just could not help myself because i never read about the stuff that she wanted me to state. However, the other students seem to know the answer and so i got a bit irritated with just Life in general i suppose. Whatever information she wanted was not in the particular text that i was reading. I am not sure what to say. Anyway…just disappointed as usual with the way things turn out despite the amount of effort. This is the recurring theme of the last six years in medical school. No feedback on your performance as long as you pass. They (the examiners) were pretty explicit when we asked about them going through our examination performances, just you know, to find out where we went wrong so we would not repeat it. But as long as you passed, they ain’t going through to that effort. Their response is that we are all too used to being the top students from our respective high schools, but now that we are in medical school, it is different, and we just have to get use to being average. Fine, whatever. Because i do know that in other institutions, the medical education isn’t like this. Major pangs of regret, but what the fuck. I hope i can get this over with by the end of this year.

Anyhow, the bruise around my eye is getting really discoloured. It actually swelled up during my examination, probably due to stress.

Goodness, i am lucky i did not sustain an orbital fracture.

Black eye

Last night during soccer training, one of our practice drills was to be divided into two teams as we sprinted against the other to reach a marker first. The first try went well; our group was winning. Then the other group discovered our sprint lengths were slightly shorter, cried foul and adjusted our circuit. Then it was our second try. Clearly, a win was no longer within our reach. My teammate from the other group was on par with me as we raced to the cone. We were really that close, and i did a slide to the cone; and she did something (i don’t know what), and we collided. I felt a massive impact on my head, and was thrown backwards. I saw my teammate flying across me, grasping her knee in pain. I hit the ground and i could not move. I could only grabbed my head.

The pain was astounding. It reverberated through my head – a pain i never felt before, never in martial arts training. My first thought was i just sustained a serious concussion. My next thought was i am going to need a CT scan. And then i got quite scared when i thought about my impending exam tomorrow. My last thought was recalling patients i had seen over the years, who had sustained traumatic brain injuries and who had residual impairment in their memories and intellectual functioning. Then i heard my coach.

“Spud, Spud, are you ok?”

I would have normally responded, but i couldn’t this time. I could not open my eyes, and i was trying to deal with the pain and the shock. I think the coach got a bit afraid that something bad really happened because i don’t normally stay on the ground for this long. I usually get up, suck it up, and move along.

“Spud, get up, get up now,” he ordered, almost pleading.

Finally i got my voice back. “Yeah i will, give me two seconds.”

And then i got up, still clutching the left side of my face. The rest of my team had been stunned into silence. One of my teammates came up to me, “Are you all right?”

I removed my hand from my face, and felt a fat drop on my hand.

“Shit, am i bleeding?” i said.

My teammate looked at my face and gasped. I saw the horrified expression on her face, and promptly replaced my hand over my left eye where the throbbing pain was. It was more to protect her from the apparently grotesque sight, than for me. I checked my hands. Nope, no blood, just tears. That’s good; the protective mechanism of my eye is still in order. I know, crazy thoughts right? I do that all the time, thinking detached irrelevant thoughts to protect myself from whatever shock i am in.

We hurried to the change rooms. The parents of one of the soccer players saw my face and i saw the identical shocked expressions mirror on their faces. You know, i have not as yet, seen the damage on my face, but these people are starting to scare me. I wondered how i was going to take my exams, maybe with a huge bandage?

I grabbed hold of the ice, could not find a cloth to wrap it in and did not care anymore. I placed the ice directly on the throbbing part of my face.

“No, no!” the mother of one of my teammates shrieked.I was almost amused by her reaction. I wondered if she knew i was a medical student.

I used my bandanna instead. Then my teammate dragged me to the bathroom and i saw my face in the mirror. I just got myself a damn black eye. I looked like i had been socked in the socket. I spent three seconds at the mirror before i turned away and looked around. Visual acuity still intact. Fine.

And we strode back to the field, and i resumed training to a few protests. I did not lose consciousness, so i figured i am fine. Also i did not feel nausea and i remembered every damn second of the incident, including my teammate hurtling across me when we collided. But i was a bit worried about the mechanism of my injury. It certainly looked like i got away with it, but i was concerned because my teammate injured her knee to the extent she could not sprint. I thought in a collision between the side of an orbit and a knee, the winner would be a no-brainer. During the rest of the training, i did avoid any further headers and tackles, although i did hear a teammate yelling at me to be careful when i got too close to someone’s arm or something. I think one reason why i insisted on playing on was because i needed to prove to myself that i was all right.

I did not want to go to the emergency department because i felt fine and i did not think they could help me anyway aside from giving me painkillers, which i will refuse, because i was not in great pain (in fact, there was no pain aside from the mutterings of a slight frontal headache, and the stirrings of aching muscles at the back of my neck) and i do not like taking medications. I ran through the NEXUS criteria in my own head, ran it past my housemate (also a final year medical student and currently on her Emergency Medicine rotation) and we thought there’s no harm just waiting this out. Plus it was late; i was exhausted and stressed for my exams, and my housemate had an exam this afternoon. I called a couple of other close friends just to let them know what was happening (and got bombarded with the same exact medical questions that i have been asking myself) and then a friend’s partner who is an Intern told me to get my arse to the Emergency. Any injury that involves the orbit should not be taken lightly. To be honest, i did worry about the risk of getting periorbital cellulitis or orbital cellulitis because they are medical emergencies and i could lose my sight. But i thought i was over-reacting.

Anyway, my housemate and i did trudge up to the emergency. We walked out after four hours. It is a long story and i have no time to blog about it now, but the nurses or nurse practitioners were incredibly rude and really incompetent. We were just appalled this could happen in a major hospital. They did not realize we were medical students, and we did not inform them either. The two patients before us had also walked out without getting treatment. And folks, the emergency department was quiet. There were three patients? For fuck sake. I was very appalled by these nurses. Anyhow, that will be another entry. So that’s that.

I did not get an extradural haematoma (i was wondering if i will wake up from my sleep) and certainly (touch wood!) not a subdural haemorrhage. Got to get back to studying now. More tomorrow perhaps.

Thinking of home

A friend MMSed me a photo of the sunset sky of my homeland the other day.

Familiarity

Sometimes i do miss the homeland. I don’t know whether this is the right time to go back.

If going back means i may have to give up my plans to practice developing medicine, should i still go back? Contrary to what everyone says, sometimes it is not possible to get the best of both worlds.

Why is it so difficult to learn from my mistakes?

I find it rather puzzling that learning lessons from my mistakes can be such an apprehensive matter. Applications to hospitals have closed quite some time ago, and it is now the period of interviews (and exams). (It is a very terrible arrangement, i can assure you. What should we focus on – our exams or our interviews? Doing badly in either will be a life-changing event; but i suppose medical students are super-humans, aren’t we? I should not be complaining though because i am a bit more fortunate compared to the rest; i will explain more below.)

Most of my peers are attending several interviews. I only have two, and i am trying to secure another, even though that’s looking like a very lost cause. This is my doing. I only applied to three hospitals; most of my peers applied to at least five. Out of my three hospitals, only two require an interview. Out of the average five applications of my friends, all require interviews. Why?

That’s because almost everyone applied to the larger popular hospitals. In fact, i do not know of any who has only applied to smaller hospitals, like me. I am in fact, guaranteed an interview with the hospital i have spent most of my clinical years in – a rather elitist and prestigious hospital. I gave up my ticket much to everyone’s disbelief and bewilderment. So much so, i felt compelled to just rock up for the interview out of peer pressure (i did not).

In fact, this time round, i forbade myself from even considering applying to any of the large hospitals. The hospital of my preference (in my home state) is a medium-sized one, and one that seems to have quite an infamous reputation amongst everyone. Apparently it is supposed to be the hospital that people use as back-up if they can’t find a job elsewhere. Now when i think about my irreversible decision, i feel almost scared; afraid that perhaps i may have made the wrong decision after all.

There is a very strong rationale towards my decision. My interest in Medicine was very nearly extinguished and at multiple points of time in medical school, i wondered if i made the right decision to enter medicine, that perhaps i may be cut out for something else. My university experience is not brilliant – i personally feel my institution has a very disorganized curriculum and there was never a point in time where i felt i belonged to a community. I felt very detached from medical school and now when i look back, i actually feel kind of sad that i did not have a much better University experience. I think the only reason why the last few years did not turn out miserably was because i have been making a proactive effort to extend my network outside of medical school, to get the happiness and satisfaction that medical school is not providing for me; which is quite a challenge, seeing how i spent most part of the day, most days of the week, most of the year, in medical school. This is the reason why i am doing so many extra-curricular activities, and one that a lot of people do not understand (not that i tried explaining to them anyway).

I reflected and analyzed and i realize my first mistake was to choose this institution to learn medicine. I was actually offered Medicine by another University, but one that is smaller and less prestigious. I accepted that offer because the lifestyle arrangement suited me. Unfortunately, i got another offer – from my current institution, one that is bigger and much more prestigious. At that point in time, i really do not give two hoots about prestige. Hell, i was not even aware that Universities had rankings in term of medical schools. I mean, geez, we are talking about medical schools in a developed country; surely any one can’t be too bad? Under social pressure, i withdrew my offer from the smaller university and chose my current institution. It isn’t pleasant. I should be grateful that at least i did not drop out of Medicine altogether; that i realized i love what i am doing, but not the current environment i am in. I could not adapt to the lifestyle and after two years of battling a near depression; i spent a heap load of money to make radical changes to my lifestyle – got a dog, and moved into a house that accommodates a dog (after much bargaining and under-the-table agreement to a rent hike over the other tenants). All these would have been unnecessary had i just stuck to my original choice of university where it was cheaper and easier to live with a pet. That’s mistake #1.

Mistake #2 came three years later when it was time to select the hospitals where i wanted to do my placements at. The selection was random but you put your preferred hospitals. I chose the hospital that was the most prestigious, and one that was over-subscribed to. By a stroke of luck or fate, i got lucky and got my choice. I paid the price dearly. I do not enjoy competitive environments. Competitive environments attract frazzled, back-stabbing, selfish, self-centred and arrogant people and i do not like mixing with them. I grew unhappy. I still tried my best to manage my workload, but i did incredibly badly. So badly that i no longer feel despair or disappointed. I was just very very very furious. Mad with myself. Angry with the environment i was in. I think it finally hit me that i am just different from most of my peers. What they like ain’t what i enjoy.

My environments can be prestigious and much sought-after, but as long as i am not happy, i am never going to do well. And when i don’t do well, i become even more miserable; and it just goes round and round in this stupid circle. I decided to put my foot down and end it. I mean one mistake is forgivable, twice is frowned upon, and three is just plain stupid. Two weeks ago, i decided to rectify my mistakes by refusing to even contemplate the big hospitals. I pored over the medium-sized hospitals that seemed to be everybody’s rejects. I love the presentations conducted by the smaller community hospitals; everyone else was less impressed. I was disgusted by the big hospitals yet everyone was smitten. It was kind of weird.

I am not saying that large hospitals are terrible. I am saying that i think i am more suited for medium-sized hospitals. Plus i would prefer to do my first year of training in a less cut-throat environment, where i can learn my skills in peace and confidence, instead of being bombarded every second minute in a really pressurized environment. Once my fundamentals are packed solid, i can move on to conquer the larger hospitals if i want to. It makes logical sense right? Yet i still feel this minute sense of loss when i see my peers embark on the paths i would have taken if i had chose not to break from this self-destroying routine. I also know this is a big gamble i am taking. What if my friends learn heaps more in a larger hospital, and my own training is neglected in the smaller hospital? Won’t i be at a disadvantage? What if they are favoured for training programs just because their hospitals are more prestigious?

That’s all valid points, but i also know that i want to force myself to step out of my comfort zone. I want to try the less conventional path and i want to know if i can excel despite it. I want to abandon the high-flying ways that i have grown up with – to always strive to be the best, attend the most prestigious institutions, to complete my training as fast as i can. I just want to be a good doctor, someone who is competent and yet not too up my arse to understand what my patients really need. I want to push myself, to see how i can handle being in a very different environment. I want to know if i am adaptable, that i really can surpass boundaries placed on me by my environment; and to be honest, i feel the small flutters of a butterfly in my gut when i realized what i have done; the small fire of excitement of the unknown. And that makes me happy.

I just need to believe in myself and to have faith. As long as i persevere for my dreams, surely it will come true one day, despite the convoluted route i have chosen to take?

I CURSE you!

I will RESTRAIN myself.

I will not buy an iPad.

At least not till after your exams, whispers a small voice.

Argh. Something tells me i am fighting a losing battle.

But now i can read journal articles in the living room without having to lug my massive laptop around.

I get to listen to music on the go!

I get to watch my podcasts!

I don’t have to scribble appointments in my Moleskine; i just use the iPad!

Shit. I think i just lost a battle. God. Not till the end of next week, please.

Isn't she pretty?

The Sunshine that caused a passing rainfall

Took the dog out for our evening walk yesterday. The weather was much nicer than the past few days where both the dog and i were cooped up in the house by the raging storms outside. At one point, i wondered whether a tree would come shattering through my windows. As we round the usual bends in the neighbourhood, i suddenly felt my dog jerked backwards on her leash which is very unusual because she usually pretends to walk beside me when really she is trying to tell me where she wants to go. Yup, this is the same dog that passed her Basic Obedience and is now on her intermediate levels. What can i say? She’s exam-smart.

Anyway, i turned around and there was this puppy that had barreled herself excitedly into my dog’s rump. My dog clearly took offense and lunged at her causing her to stumble backwards in bewilderment. I steadied my dog. This pup was three times smaller than my dog. Also my dog can be protective. This little one came sniffling up. I must say, my dog must have recognized no threat from her because she became a little less aggressive. I glanced up and down the street for the owner. I really don’t like dogs off their leads – they tend to mistake my dog for a gentle mutt and attempt to be friends. My dog wags her tail, tolerate a few licks and then she will lunge if they don’t stand back.

A Chinese guy came jogging up the street. The pup ran up to him and jumped up. He paused and glared at me. I stared at him, wondering what his problem was. Then he jogged away and the pup came running back to me. Then it hit me. This guy probably thought i was a moron, letting MY dog jump on strangers. And i thought he was an idiot for being so rude when it was HIS dog that disrupted my walk. The point was, this pup was on the loose. I decided to proceed on with my walk, because i do have exams to think about, and i was already wasting precious minutes. The pup followed us.

Suddenly one of my neighbours came out.

“Do you know whose dog this is? I have never seen it around and she came into my house just now.”

“Nope, never seen this dog before either. How long has she been out?”

“Past forty minutes maybe.”

“I guess she is going to follow me now,” i said in amusement.

He laughed. He too has a medium-sized dog and one as fickle-minded as mine. Plus he has a young kid at home, so i guess keeping the pup safe was not possible. In the end, after crossing a road, and witnessing the pup dashing with me; i grabbed hold of her and carried her. She was surprisingly comfortable in my arms – no squirming or growling.

We met another dog owner in his garden. His Shepard X ran up to us. My dog lunged, and the puppy started wriggling out of my arms to join the fun. It was a bit mad.

“Do you know whose dog this is?”

“Oh, it isn’t your dog?”

“No. Anyway, i live on XXX street; if anyone comes round asking, the dog will be with me.”

“Sure.”

Little dog lost - in my friend's arms.

And we continued on our walk which was now taking too long. And longer still because i had to carry the pup and reminded my dog to heel. Didn’t help that another sheepdog off his leash came barking towards us as he raced with his cyclist owner down the road.

“Sorry!” the cyclist hollered after me.

I shrugged. Some days, when i walk my dog, i meet no one at all. Other days, i get followed by one, and meet a whole string of others. Life’s weird.

Back home, the two dogs started playing and chasing one another, out into the backyard, back into the house, and so forth. I attempted calling the pup ‘Sheila’ but that had a bad ring to it, and my housemate was horrified. My housemate wanted to give her a French name (she’s learning French at the moment) – triedcalling her ‘Nuage’ (Cloud) but i just stumbled all over it trying to pronounce the complex name with a French accent to boot. In the end, i called the dog ‘Sasha’ and to our utmost amazement, she responded.

I was going to do some studying and hoped the owner come round but nearly one and a half hours later, there was still no word. In the end, my friends and i took her to the animal hospital to see if she was microchipped. I thought if it was me and my dog was gone, i would really appreciate someone calling me. Unfortunately, the dog was not microchipped. Why do people not chipped their dogs?? Not to mention that it is illegal in this country. The vet nurse was really rude to us. She wanted to take the dog without our permission. When i said no, i will ask my local vet and hold on to the dog lest the owner does come knocking in the next few days, she asked me what the hell would i do with the dog anyway. I was quite taken aback, but she was saved from my reprimand because just at the moment, my housemate called to say the owner had come round to my house. Blasted nurse. She does not really have good communication skills.

There was a young family before us who brought in a cat because it was hit by a car. The lady was crying. Yet, the nurse chatted on the phone whilst breaking the bad news to them. My friends and i (all medical students) were simply appalled. But the family did not look that upset. I mean if my dog was going to be put to sleep, i doubt i would be that calm. Also i hope that cat was not a stray but their pet, because the lady was pregnant and stray cats carry Toxoplasmosis, which is really bad news for the fetus.

At the animal hospital.

To cut the story short, we sent the dog home and we found out her name was ‘Sunshine’, no wonder she was responding to ‘Sasha’! The family just moved into the neighbourhood, and the dog had dug a hole out of the backyard. His young son was sad that the dog was gone. I told him to get his dog microchipped because she is adorable and if someone else finds her, they will probably keep her instead.

This just reminded me that the same thing happened to me when i first moved into the neighbourhood three years ago. My dogs figured out how to open my sidegate (despite it being padlocked – just lift the stand at the bottom and the gates will swing silently apart. I know this because i spent a good fifteen minutes after the incident staring at the gate, trying to sort out the trick the dogs had used) and they were puppies at the time. They took off running down the street and playing. My street is a busy street; there’s a hospital a few houses down. Anyway, a kind neighbour picked them up and brought them home (my dogs had identification tags on them). They re-secured my gates and left me a note. I only came home twelve hours later (this was back in the days when i was juggling med school and a part-time job), and when i saw the makeshift lock on my gate, i thought someone had broken into my house from the backdoor. The neighbours drove by and told me what happened. I was very grateful someone looked out for my dogs. Not surprisingly these neighbours were fellow dog owners – they have two German Shepards of their own.

So that was how last night went. I did little studying and am way behind my schedule now. I am stressed and i can’t help but wonder how these strange incidents happen to me. I am not complaining; i am just curious. Life’s little wonders.

Sunshine, the Schnauzer