Monthly Archives: September 2010

“So, what is the most interesting thing you have learnt in General Practice so far?”

That was the question posed to me by one of the GPs. It is a known fact in that practice that i want to specialize in surgery, and not just surgery, but Trauma surgery. So everyone knows that i need to live life on the edge of my seat or i will be bored to tears. The GP consultants i sat with have all been absolutely fantastic – i have never met anyone more patient and more amicable than them. Sometimes, i wish i have not known them, so then one of them could be my GP instead, because a good family medicine doctor is hard to come by. Anyhow, whenever a patient walks in with something that vaguely requires a procedure done, the GP in charge would come striding down the corridor and tell me to haul ass into the treatment room because the fun is about to start! I really appreciate their kindness.

Anyhow, so this GP asked me this question; and i kept silent for a while – partly to rack my brains to come out with an answer that did not sound that i was bored to death (I was after the first two weeks, because the patients after the first two weeks were just a repetition – prescriptions, blood pressure, rashes, sniffles, antenatal questions etc etc etc). And then i just thought i might as well be honest.

“The most interesting thing i have seen so far is Shingles,” i replied.

And it is true. I have seen three cases of Shingles; one almost becoming a Ramsay-Hunt, but not quite there yet. Three cases, and all in different sites, different age groups and completely different-looking lesions. I have now learnt that if the skin rash is something i do not quite recognize, i swear i am just going to put my last dollar on bloody Shingles.

The consultant looked startled with my response so i hurriedly explained myself.

“I never see Shingles in the hospital settings; not on the wards and not in the Emergency Department.”

“You are right…” the GP replied in surprise as she mused over what i just said.

“The other condition that i see in GP practice but hardly in the hospital setting is acute bronchitis,” i continued.

Seriously guys, anyone who comes in with a cough; nothing but a cough and perhaps an occasional sniffle, just have the unspecific diagnosis of acute bronchitis. I ask my list of courtesy questions and will come out with nothing but just a dry cough irritating cough that persists day after day after day. The chest examination would be clear, there will be no fever, and really just nothing to find at all; except for a very expectant patient. They all expect to be prescribed antibiotics as though it was some sort of magical elixir that will cure them of all their ailments.

Theoretically, we should not be dispensing antibiotics when there is no need for it because we will just be encouraging bacterial resistance. In real life practice, it is just different. My consultants explained to me that some battles can be fought and some cannot. If the patient comes in, determined to get a script for an antibiotic, you are really helpless to do anything. You just need to pick your battles.

Then there were patients who google their symptoms. I think reading up about your condition is a good education for oneself but to take what you read on the internet over what the doctor says, can be plain ridiculous. For example, this lady came in with possible seizures. (We do not think so – there are none of the usual symptoms like incontinence, post-ictal confusion, focal neurological deficits etc. Plus it was the wrong age group; this lady was too old to be diagnosed with epilepsy.) Yet the husband comes striding it and says his wife has seizures because he read about it on the net. When we asked more specific questions to clarify the symptoms, he retracted his initial statements and phrased them in the medically-correct way to make it seem like epilepsy; except his attempt to appear genuine was poor and we could tell he was reiterating what he read on the internet rather than what his wife really exhibited. Then he said he tried to force-feed some diazepam pills to his wife in the middle of her so-called seizure but it was impossible. He wanted a faster-acting drug. I just stared at him incredulously. In all his internet searching, did he really lack common sense? Did he not know you should not be forcing anything down anyone’s throat who is in the middle of convulsing or thrashing or whatever lest they choke? Hmmm…see? Definitely not seizures.

I have no patience for this sort of people. I would just brush them off, and really they should give me a wide berth. I can imagine the scathing remarks some of my surgical consultants would have meted out had they been confronted with such patients.

So GP has be an eye-opener, but i am glad it is coming to an end. I am also relieved to say that i am NOT a convert. Phew. Needless worrying.

Up days and down days

I need to de-stress a little as i rest my aching shoulders. Just hung up 1.5 cycles of laundry (the additional 0.5 was wet laundry that i did not have time to hang from Sunday, and therefore went back into the machine for a second wash to get rid of the stench of wet clothes that had clumped together for a long time).

Yesterday was an up day and today is a down day. Monday was a so-so day, and i wonder what tomorrow brings. Soccer social went well yesterday. I am starting to get comfortable playing as midfielder-striker, learning how to create opportunities and where i should be standing. I also learnt to dribble a little. Though i did not score any goals, i did have five shots on goal and i was getting quite frustrated. I found out that many of the players who were playing the social were from Division one (i play Division 3) so i am really happy because that means i get to work on my skills with more experienced players, without the pressure of performing because it is a social.

Fight between Stegosaurus and Triceratops (image googled)

There were three new players who joined the game – they too belong to an outdoor soccer team. I have never seen them before so they are probably of a higher division too. One of the players took to defending me by literally adopting rugby scrum tactics. The first thing that came to my mind was that of Stegosaurus and Triceratops because she was doing exactly that to me! I was amazed because it was blatant and dude, we are in a friendly match. Anyhow, it did not bother me too much, i guess because i know i can easily win the challenge if i had to. We also played a full sixty minute game without a rest. I did not keel over at the end of it, so i knew i had become fitter.

Today however, was a bit of a disappointment. Just when i thought i was finding my footing, i sunk into lost mode again. I went for group soccer training session and just could not find the correct passes and crosses and actually gave the ball away in many instances. It was not all bad, and there were some crosses that i lobed in pretty well (it was pointed out by the coach; i do not believe in self praise!) but i had only one shot at goal and this time round i could not tell where my teammates were and i felt very much under pressure. Not sure why. Of course i know that there can never be all good days in soccer. Some days you can try your best, and the crosses don’t happen, and the opportunities do not open up. Other days, it is effortless to create chances. Still it does not feel good though – i think i am really pushing myself in soccer now. I ought to calm down.

All right, i should get some studying done. I am so annoyed. Close to midnight, barely enough time to study. Promise i will talk more about what i did on my GP rotation. There were certainly interesting things i did; but really most of the time i am bored shitless out of my mind. (And i am surprised to discover that the GP consultants i sit in consultation with; admit to the same feelings. Oh well.)

Commerce without morality

The new neighbours that moved in six months ago, are moving out again. I found out that their landlord, also my former neighbour (and a pretty uptight woman, who only became friendly to me when i started giving her the cold shoulder i.e. not bothering to greet her when i see her – that sort of person who responds only when you are aggressive) had increased their rent. In less than a year of their lease. I do not know the new neighbours at all, just an occasional smile since i hardly run into them; but if i were in their shoes, i would be pretty pissed off. In fact, i was surprised that anyone would accept the original rent (the rent before the hike!) since it was as dear as living in the damn city itself. Clearly my former neighbour pushed her luck too far this time.

Anyway, the moving truck came yesterday and i saw my dog do this:

Very very curious about the neighbours

Yup, she stood on one of her kennels and peer across the fence in curiosity. Probably trying to score herself a pat from the neighbours. I know my neighbours’ gardener was really amused and gave her a pat once.

Sunbathing - clearly no shortages of kennel roofs to choose from.

She sleeps in the smaller kennel (more cosy i suppose) and usually sunbathes or keep an eye out for our property on the larger kennel. I bet people who pass our house and see her relaxing on top of her kennels must be very amused.

Under $8

I went to Borders yesterday whilst waiting for my friends. I didn’t think i was going to buy any books since Book Depository has most books much cheaper. Until of course, i came to the bargain table, one that is not usually out on display, and one with the signature 3-for-2 books. Every book was going for $6.99, and they were throwing in a free book for every two purchased. I knew then that i was in for some spending. Book Depository may be cheap but if the books are going below $8, even the online retailer can’t match that. Sure enough, i picked up enough books that i would read but would never purchase if i were on a book-buying spree with an aim – the kind of books you tell yourself you want to read but could never bring yourself to fork out the money because there are many more books out there worth buying.

So i bought myself four crime mysteries and thrillers – ones i can get through in one sitting; the type that really ain’t worth $20 (usual price) because their shelf lives is longer than their reading lives. Four books for $20? Now that is a different story. I bought Prey by Michael Crichton, Never say die and Call after Midnight by Tess Gerritsen and Obsession by Jonathan Kellerman.

Already i have completed Michael Crichton’s Prey and i was amazed to realize that his books are not as esoteric as i made them out to be when i first read one in high school. I think the subsequent years of education i had made it a little easier to read his material. I am now going to get my hands on the rest of his collection.

I lovingly placed my new purchases on my bookshelf, and arranged them with my other books. I stood back and admired the two towering bookshelves that dominate the dining room, and i realize that before the end of this year, i will probably be getting myself another IKEA bookcase. When my parents fly up to visit in about two months, my mum will be hauling more of my books from The Homeland. She redeems Borders vouchers for me from the credit card points she accumulate, just so i can satisfy my reading habits.

Anyhow, after browsing through the books on my bookshelves (many purchased from years before, still unread but not untouched because i haven’t found the time yet), i started on Ken Follett‘s The Third Twin, bought three years before. I am just a bit worried that i seemed to have embarked on a reading phase that usually hits me only when i am on vacation; and my exams are in five weeks. Hopefully, this will be the last fiction before my exams. I need to get some serious studying done.

Afternoon walks

I had time today to nip back home during lunch break between clinic sessions. Since i will be out tonight, having dinner with friends, i took the dog out for a walk. I miss afternoon walks with my dog. Our routine walks always occur late at nights when i finally find some breathing space from my various commitments. It can be quite lonely since there is usually no one else walking their dogs, and most dogs are in the houses with their owners so no dogs to bark at us. I know it is strange; maybe some people like that it will be a quiet walk. But to see the other dogs in the neighbourhood barking at us excitedly as we walk pass, and the dog and i staring at them in amusement; is well, quite cheerful.

Afternoon walks are great. Most people aren’t home, so their dogs know they can yelp to their hearts’ content. Most dogs would also be out in their yards, peering through the gates, waiting for the next canine visitor to walk pass, which happened to be us today. It was kind of fun to see the various dogs react. The sunshine felt good, and i could see the various builders and tradesmen working hard on the new townhouses, and the stay-at-home mums tending to their kids.

All right, enough nostalgia. Gotta eat my lunch and head back out.

Sports vs studies

I just came back from BJJ training. Small cut on my lip, no big deal. What worries me is this insurmountable exhaustion that i can’t seem to shake off. I am finding it increasingly difficult to maintain a fitness regimen and still put in adequate studying.

So far the highlights of this week included starting a social game of soccer with girls i have never met before. I find it remarkable how far along i have come – from the quiet, almost shy girl in first year of Medicine to one who brazenly walks into a group of strangers, say a cheery hallo, introduce myself and dive straight into the group dynamics. I have to admit that age probably plays a factor. At this age, i really could not give two hoots about being self-conscious. I guess as long as i have no boob hanging out or a huge stain at the back of my pants or anything like that, i am fine.

My team mate (from outdoor soccer) has been telling me how much my game has improved over the past season. I never believed her; i also thought she was being nice and encouraging. But that day when i played social soccer, and was running upfront, i actually scored a goal and took several shots on goal. I was very amazed. It was also the first time i finally realized that maybe learning all those dribbling skills will be within my grasp. Then the next day when i turned up for soccer group coaching session, i scored another goal and had more shots on goal. I could feel my confidence taking a little soar. It felt good. I hope it was not beginner’s luck, but i am gonna keep working on my skills.

It also made me wonder about something – remember how i was whinging when my coach (from the outdoor team) kept fielding me as striker, and i absolutely abhorred it? I am starting to think maybe he saw something that i could not pick up on. Maybe i am better as an offensive player than a defensive one. Anyway, since i am constantly playing midfield (not sure why, but i somehow always drift upfront, and when i play with people i do not even know, we always seem to naturally fall into a formation where i am somewhere upfront), i am also getting more familiar with my role and my responsibilities, so maybe that’s why i am starting to be a little better too. I guess i just need to keep forging on.

Scarf hold (Source: Ultimate Jiu-Jitsu)

As for BJJ, i am getting stronger. I keep hearing my training partners telling me that i am very strong and i always tell them that it isn’t the strength but my flexibility. But today one of the male martial artists corrected me and said i am both strong and flexible. I was a bit loss for words. Anyhow, today i changed tactics. With the stronger players, i keep getting flipped. I tried scarf hold (my signature move apparently), and focused on getting my base right yet i was still getting flipped onto my back. Now i am starting to think that perhaps with a strong opponent, a perfectly executed base is still insufficient. As long as they possess the strength to lift me completely off the mats, that technique ain’t going to work. So i switched strategies. Because i am a junior belt, i decided perhaps i should just work on my guards and prevent the senior belts from escaping my guards. I did well – no amount of struggling could pry my legs or arms off them, so my opponents could not create a submission. However, the drawback is that although i did not get choked or arm-bared, i was also not learning how to create submissions on them. The only thing that i learnt was that i am absolutely knackered from all that desperate effort to remain in guard position.

I think the guys are also a little horrified at how flexible i am. One of the instructors accidentally rolled over my hand, and we both heard my thumb popped. He got a fright and thought i broke my thumb. I merely straightened my hand and my thumb slid back into place (i have never done this before and although i can’t say i am surprised that i have such an ability, i also cannot claim that my flexibility extended this outrageously) and his jaw dropped. I overheard him telling one of the other instructors when i was in the middle of a grappling bout and my opponent could not arm-bar me despite having my arm in the right position.

Anyhow, the point is i am really tired from all these training. I mean i could stop these trainings but i also know that we need to work-out at least an hour everyday to remain fit. Even if i do not attend these training sessions, i will be at the gym running on the treadmill (or at home using my rather dusty and still quite brand spanking new 3 year old treadmill) and i will not be pushing myself quite as hard so the training value will be ridiculously low. Hence, i refuse to stop training; also the number of friends i have made is invaluable. But i always find myself unable to do any studying. I come back from clinics, sit around a bit or practice my flute, then rush off for training. When i get back, i walk the dog, eat my dinner and it is almost 10pm. By the time i am done with my shower and all settled down, it is 11pm. By which time i really should be in bed because i start early the next day. Can’t get much studying done. Not sure what i can do about this.

The frustrating part is that i am not learning much from General Practice at the moment and i am truly bored out of my fucking mind. I have been seeing patients on my own and i swear to God, everyone either has a cold or is in depression or is after a script. I curse inwardly whenever a GP kindly ask me to see a patient on my own. Don’t get me wrong – the GPs are nice and really i guess i learn crucial skills by running a whole consult by myself but i am not mentally challenged that sometimes i suspect i am using my sports to run away from reality. I used to feel devastated whenever a depressed patient came in and did not want a medical student in attendance. Now i realize that is an advantage because instead of wasting my time pretending to be interested in the consultation, i can actually get some serious studying done. Anyhow, before this rotation i genuinely feared that i may be a convert – that is deciding to be a GP instead of a surgeon. Now i know my initial choice is still correct – i can’t stand this insufferable periods of long interactions with patients. I can do quick ten minute consults and then zip into theatre to do some proper challenging work but i cannot spend 30 minutes talking about weight loss, diabetes control and the importance of avoiding hypertension to a patient who is not interested in their preventative care. Argh.

Subwoofer

I just have to say this.

Last night i went to the supermarket to do my weekly grocery shopping. As i was about to leave the underground carpark, i felt this unpleasant thumping and throbbing in my head, except it wasn’t really in my head. It was coming from my environment and affecting my head. I don’t suffer from vertigo or any ear imbalance, and i do not easily get motion sickness or something along those lines, but this highly irritating subwoofer bass was causing me a lot of grief. It didn’t help the windows were down because the dog was in the backseat, and i usually let her stick her head out to watch the world go pass.

I hurriedly pulled out of the parking lot and exited the place. To my horror, the sound followed me.  I swiveled around to search for the root cause of all this evil and i saw the troublemaker. Some moron in an orange beat up car that had raced into the narrow underground carpark and made a screeching lap around the other cars. I thought he was going to get some stuff from the supermarket but clearly he was just trying to show off his useless skills. God, why do guys do this? Seriously, have they no brains in their skulls? He could have caused an accident with his mindless stunt.

He followed me all the way out to the traffic intersection and i have to say, i was really affected by the racket his god-damn subwoofer was creating because i nearly overshot a fucking red light. My temper flared unreasonably rapidly; something that has not happened in ages. And i cursed that bastard on the spot. Thankfully we parted ways at the intersection.

Why do people behave so ridiculously? Do you know how pathetic it is if complete strangers can wish ill upon you even though we never met? It must be a pretty wretched existence.