Sunday, December 5, 2010

Keys

31 Nov 2010

Moving out of the Village for the year, we had to have our room inspected. They wanted to know that whilst staying there for the year, you did not punch a hole in the wall, or grow a little fungi kingdom that has statues of you as their god. After 2 days of cleaning and moving out, the inspection itself takes 5 minutes, and I was asked to hand in the key or I had to hand it in myself.

I returned my locker keys back to CAU yesterday, so there are only my village keys left on my key chain. All of a sudden, I have no keys left in Australia. I had a weird moment of panicky feeling, and a sense of lost. It's as if all my time here ended up in nothing, and now I'm being exiled.

Besides unlocking doors, locks, ancient treasure chests, and serve as an analogy for how enzyme works; like an anchor, keys also represent some sort of connection to a place. Having an establishment, a foothold, a home. What is the first thing you do when you go home? you fumble for the keys in your pocket.

It's weird without a key.

Sunday, November 28, 2010

Back to Civilisation

After months of hermit life, shutting away from any connection to the exciting outside world, my exams are finally over, and I am back causing trouble. There's a slight fear nagging at the back of my mind still about whether I have passed the year or not, and this won't go away until I get the confirmation.

For now though, I need to plan my holiday. I always start my holiday relaxed, a little too relaxed in fact, that by the end of it, I have yet to do any of the things that I wanted to do, books to read and notes to sort out.

It's only been 2 days post-exam, and I've already formatted my laptop, moved half of my room, and bought celebratory Champagne for my brother who's graduating in a couple of weeks. There's a list of 100 BBC recommended books on Facebook, it says that on average, most people would only have read 6 of them. The unfortunate thing is that I have read less than the average person, time for some serious reading in the coming month :)

Monday, October 4, 2010

Perpetual motivation Theorem

It's 9:25, I have got up after a 6 hour sleep, got ready, walked downed to Hudson's at FPH for some muffin and some warm embrace of the loving Caffeine. Already I can feel the bookworm in me starting to wake. I'm usually most ambitious about study at dawn and dusk, or whenever I am not sitting in front of the books. Once I do get myself organised and sit down, the motivation begins to drain bit by bit, like losing protein in a nephrotic patient. The war of attrition eventually wins out and I end up on facebook 2 hours later. I do find that the more distractions that I need to address for, say, get some tissue or a new highlighter from across the room, the quicker my motivation thins out.

Wouldn't it be wonderful if from my seat, I can have access to everything that I ever need for study at arms length? Enough highlighters to colour the whole book, out or inside the line; all the caffeine I can take before crossing the seizure threshold; all the books I may need to look up the most obscure facts like, Dandy-Walker syndrome. No, even better, surround my work-station with a wall of glass and have the computer project onto it. It'd have to be multi-touchpoint controlled by detecting my hand movements like the one in Minority Report or Iron man. When I pull up textbooks, it'll automatically do a keyword search for whatever I am thinking, so I won't have to read more than a paragraph for my answer. A workstation is not complete without a mini-bar and snack trolley. And the seat turns into a treadmill when my bum numbs from all the sitting down.

I think I will be able to study forever in that seat, my motivation will never feign, like a perpetual motion machine. My 'Perpetual Motivation Theorem' therefore states that, when in a comfortable seat, and supported by well thought out features in a workstation, and with enough supplements; a person can, in theory, study forever without tire of whatever knowledge that is being pursued.

Science will get there one day. One day.

Tuesday, September 21, 2010

Metallica - World Magnetic Tour

This would be one of the most memorable concerts, for the first time I experienced moshing.
I usually go to concerts alone. To prevent from dying from boredom waiting for the main act to come on and the risk of listening to crappy support bands, I often turn up just on time or slightly late. No self-respecting hard rock band would come on before 9 anyway.

Not this time though, I flew in to Melbourne early during the day, frolicked around the city for a couple of hours with my heavy bag slung across the shoulder, and walked from one end to the other (from Queen Victoria Market in Northern side to Rod Laver in the South). There is no better way to see a city than on your feet. I found an awesome bookshop (Reader's Feast), which I'd certainly have missed if I was in a car. It is surprisingly grand for its deceptively small entrance to an underground arcade. The National Gallery of Victoria (NGV) had an exhibition of paintings of European Masters from Stadel Museum that was quite impressive, and in retrospect, quite a contrast to what I was going to experience later.

Rod Laver had a centre stage surrounded by standing area, then seats all around the arena. The band gets to run around to face the audience on different sides. The drummer (Lars Ulrich) had a spin-table under his drum set, so throughout the concert, he was rotated around to face the crowd. I arrived quite early, so I was on the railing, an arm length away from the stage. It was an exciting notion to begin with, especially during the two supporting acts. I had never heard of them before and would probably not listen to their angry music by choice, but being so close and upfront with the band, they did sound agreeable.

When Metallica finally came on after a 20 minute intermission, the crowd got wild. I didn't go to the concert expecting to find Metallica fans to wear pink T-shirts with rainbows and unicorns, but I wasn't prepared for the moshing. I have no problem with people throwing their fists up in the air, shouting, screaming and jumping, but it became a problem when people behind you start to push, I was trapped in between the momentum of the crowd and the railing that was waiting to crush my squishy lungs. I couldn't beat them, and so I joined them. At one point my feet were totally off the ground drifting in the waves of human tide. When I finally made it to the back of the crowd, I was exhausted, I had lost my precious spot right up the front, but I was glad that I survived. From the back, it was an interesting sight to see people like sardines, squashed together, mash towards the stage. I remember thinking, this must be what ancient/Medieval battle line feels like. I had my suspicions when I noticed that the guy wedged his way to the front had a tatoo of Ned Kelly on his back.

It was a great concert nonetheless.

Monday, September 13, 2010

Labelling


Have you ever noticed that when you lump a positive word and a negative word together, it somehow just makes the negative word seem bearable, less concerning, and sometimes even adorable?
Example: Sick puppy.

It's like the two words go up to a bouncer, and the good word says, "it's ok, he's with me." And they both get in the club.
Example: Evil kittens.

Prefixing something with "baby" automatically supercharges it with cuteness. Like instead of foal, say baby horse and everyone loses their shit and is craning their neck to see the "baby horse" out the window.
Example: Baby ducks. Pygmy baby hippo. Killer baby. Hairless monkey.

Add an exciting word in front of something plain and boring instantly make both of them sound exhilarating.
Example: Cool bananas. Robo Cop. Turbo bunnies, Turbo pony, Turbo whatever. Sexy Lingeries.

Wait the last one doesn't work, both words are exciting.

Can you think of anything?

Monday, August 30, 2010

Awesome day

I had a good day today.

In the morning I dragged myself out of bed slightly early because I'm starting my one week in AMU. AMU is the brand-new unit at the hospital, kind of like an expansion of ED. To the untrained eyes it may seem like a bazaar where the different medical units come shop for their patients. For those in the know, it is a bazaar where different medical units come bid for their patients. I should explain later.

Hand-over served no more purpose than to watch comically the 6 consultants from different units sit around a long table, debating and jousting with knowledge of antibiotics. As my repertoire of antibiotics consist of 2 or 3 everyday use ones, and 1 or 2 oh-shit ones; I spaced out after 20 seconds, but it was fun to watch nonetheless. When we got to AMU, found the person in charge and introduced ourselves, we were told that ward round doesn't start until 9 and it was only 8:30, go have some tea or something. 10 minutes later I was enjoying my morning cappuccino from Hudson's. mmmm...first win.

The ward round at AMU is quite a sight. 5-6 medical teams, nursing staffs, clerks, medical students, interns, 50 or so people crowd around one white-board with all the patients' names and conditions. Each patient is to be assigned to a medical ward. Where they end up depends on negotiations between teams and the coordinator. Precious bed spaces and workloads are bargaining chips. As each medical team disperse to check on their own patients, we found our consultant, who wastes no time in sending me to assess a new patient.

I found the patient in a negative-pressure isolated room, he's quite slim, looks run down and extremely bored. He's my age, and is locked in this room with no TV or any form of entertainment since Sat night, visitors need to mask up to enter the room, so not many bothered. It's an hassle just to ask for a cup of tea. Difficult historian, rather dismissive about his symptoms, but I got it out of him anyway. When I presented the case and Dx to the consultant, he said that he's thinking the exact same thing. Second win.

The patient is rather standoffish, and there are bits of depression/grief issues and anxiety problems that were bubbling just underneath the stoic surface. When I talked to him alone later, he opened up, and agreed for psych team to come and chat. Third win.

Took blood from a friendly elderly lady who had fragile veins. It wasn't easy but blood did came pouring out. Had to use a butterfly and I left her a haematoma, so half a win.

Spent the afternoon at the clinic, we had just the one patient who turned out to be a medical mystery. She has had about all the tests and imaging known to man, or medics, done on her and they could not find a definitive cause of her problems. Anyway, she is very friendly also, showing me her bag that has all her grandchildren printed on, and telling me about them while the consultant is out of the room. Sometimes when you go to a clinic and the consultant is really stingy with words, there's this awkward silence in the room where you are not sure if you should make small talk or just sit quietly in the corner. What's worse is when the patient interacts with you, you are not sure whether it's ok to respond. Regardless, she's the second person I met today that smiled at me through her eyes. Fourth win and a half win.

Later, I found out about my rotations for next year. They were mostly high on my preference lists. Totally excited about next year. Another win.

Lastly, I could not miss a shot on the bball court tonight. It's like watching MJ play in first person.

I think today sums up to be a pretty awesome day.

Wednesday, August 25, 2010

Slash & Myles Kennedy concert

Wed 11, Aug, 2010.

I flew to Melbourne to see Slash and Myles Kennedy in concert at the Festival Hall. I had planned to arrive in the afternoon, dump my bag, and leisurely stroll around the Melbourne metropolis and go in early to mosh my way right into the front. Unfortunately it seems like every time I fly, something will go wrong and sure enough, I arrived at the check-in 10 minutes too late. As it appears that Tiger airway, although cheap, requires you invest half your day to camp outside its terminal ready to go. On the later flight, I was due to get there at 8pm, doors opened at 7pm. An hour late, no biggie, the opening band is probably still on the stage. On arrival, a rain storm was hovering above Melbourne and we could not land, we circled around for 30 mins before we could approach the airport. I asked the flight attendant for a pair of parachute as I was in a hurry, but he politely declined.

8:30pm on the ground, I ran from the tarmac towards Tiger terminal (was told off for it), and hopped on a cab, told the cabbie to get there ASAP. He took a look at me, asked and made sure that I was not from the city, and proceeded to drive me to the Eastern suburbs (on the opposite side of the city to where I wanted to go). After a hefty cab fair (no, its not fair, its more of a fine) and 40 minutes later, I was really not impressed with him. I'd rather tell a cancer kid that his epileptic dog has no cure, than mess with someone on their way to a concert.

9:15pm. I got out of the cab a street from the Hall, ran across the street, checked my bag into the clock room. As I was checking in...

"Look at the hate we are breeding
Look at the fear we're feeding
Look at the lives we are leading
The way We've always done before.."

Then came the blast of the two signature guitar notes that vibrated the whole venue. It's Civil War, and I know who was on stage. They had come on about 20 minutes ago, I didn't miss too much. The Hall is rectangle shaped, and the stage is right in the middle, and while the people sitting at the far end of the wings were stupid, the crowd in the middle were much more reluctant to give up their space. Luckily I could still squeeze relatively close to the stage even though I was late.

Slash had his trademark appearance: sun-glasses and top-hat, big curly hair down to the shoulder, and his Gibson Les Paul across the chest. Then there was Myles, one of The best rock singer of today, way under-appreciated. He has the voice that I'd give anything to trade for, I have loved his voice since the first time I heard him sing. I am glad that he is recognised by Slash, one of the legends of main-stream hard rock icon. They went on to play Rocket Queen, a few songs from Velvet Revolver repertoire, Starlight (my fav song from the new album), Rise Today (from Alter Bridge, a song that examplifies Myles' vocal), Slash did a solo of the Godfather theme, and encore with Paradise City.

The highlight of my night is, of course, Sweet Child O' Mine. Picture your favourite singer, a voice that you agree exactly how Rock should sound; with your favourite guitarist, ranked 2nd best guitarist of all-time; playing your favourite song live on a stage no more than 20 meters away.

It doesn't get any better than that.

Back at it again

10.5 weeks away from OSCE.

It's been awhile since my last post. I have since been to NZ and back, spent a month on the stroke ward, 1 night and day in Melbourne (Slash Concert), 1 week on acute coronary care unit (ACCU), and 2 days on general medicine. my motivation to study has peaked and waned. The sun had dawned and set like a metronome keeping the tempo, while the gale wind blasted the forte and the rain whispered in sotto voce.

Hanging out in General medicine wards makes you feel very young and very sad. First epiphany is obvious enough, and sad because you see some young frail old people and in complete contrast to old young people who don't look their age. The young frail old people are ones who are young in age, but with a body of frail old person. This is probably in keeping to their lifestyle. Then you see the 90 somethings who looks younger than they are, generally more positive and recovers better. You can't help but wonder which you will end up being.

Stroke unit is a sad place to be. The patients generally become debilitated or impaired in some way. Apart from the body functions they were deprived of, most also lose their independence, sometimes dignity too. There was the former Who's Who, whom with one word, could change the lives of hundreds; but now he can barely utter a word through his dysphasic bulbar weakness. But the saddest of all was not the lost of half your body, but your other half. I saw a lady who woke up with a devastating stroke that morning, came in to ED and there was little we could do for her. Her husband sat next to the bed listening to the Reg explain about palliative care while holding back tears. It's one of the hardest thing you can tell another person. It was just so sudden. There were family meetings where we explained to families that the prospect of recovery is grim, and pretty much directed the treatment towards comfort care. There were a lot of medical ethics at play, what we despise as written assignment highlights itself as delicate situations where people's lives were at hand.

On the ACU, I met a 90 year old gentleman who was an opera singer. He looked more like an early 80 year old. He came in because his wife died last week, and it literally broke his heart. They had been married for 60 years and now all of a sudden, she's gone. He had no previous cardiac problem, but since last week, he'd developed arrhythmia and possible angina. I am not sure how much of his story the treating team actually bothered finding out, as he was referred to as the old guy by the window bed who was crying. JD and I were going around the ward practicing history/exam, when he told us about the wife, I pulled the chairs around and we sat down. He needed a medical doctor who is also a human who is willing to just sit with him for a little.

This morning, one of the SOB patient went into AF. As we hooked the usually quiet old man up to the ECG leads and oxygen, he became very excited. "I am the machine man!" His heart rate shot up to 120 while the atria fibrillates away. I don't think he understands that his excitement was causing those of us on the bedside deeply worried. Nevertheless, If he were to go "I AM IRON MANNN....." then I probably would not be able to refrain myself from joining him in the Black Sabbath chorus. In between his machine man chants, we manage to give him IV metoprolol and I was called away.

Ending on a good note. There was an old gentleman of 85 on the ward, his wife was by his side throughout. One day as she was leaving after a visit, she had a syncope episode and collapsed on the way out, she stayed. The ward arranged so their beds are next to each other, and their beds are closer to each other than the usual estranged distance between beds separated by curtains. They were both discharged today, together.

Tuesday, July 13, 2010

Dark Ages

I woke up to total darkness at 5:30 AM. It would be normal except I cant switch on the light, Adelaide (or at least my part of town) has plunged into total darkness with lack of electricity. I would normally just go back to sleep, but I have a flight and a taxi is to pick me up at 6.

It's easy enough to find your way around the house, harder to make sure you have all the luggages, but pretty much impossible to do your hair in total darkness. Mobile light is annoying as it kept turning itself off, I found a candle and walked around with it.

It is total darkness on the streets, all of the electricity has gone along South road according to the taxi driver. The gale broke several branches and they litter the road as we drove. It's like some big disaster has stopped the world, I was getting really excited, this is it! end of it all! Then it was disappointing to drive back into the traffic lights and civilisation. I put away the savage caveman instinct that was ready to cut throat and loot the town in amongst the chaos and lawless catalysm.

Melbourne airport is gargantuous. That is both a good and a bad thing. Good because I enjoy the sense of a thriving economy; but bad that I have to stand in line for 40 mins to get through the customs with a kid throwing tantrum in the line. As predicted by the custom officer who referred to herself as an 'old gal' and was flirting with me a little and thus delaying me more, I was lucky enough not to sit next to the tantruming child. However, worse than a child throwing tantrum, is a teenage boy trying way way too hard to impress the girl next to him. I had to sit through 3.5 hours of him trying to be funny (which he is not), playing stupid (which I don't think he had to pretend), and obnoxiously trying to put a funny twist and comment on everything he's doing/seeing.

Wednesday, July 7, 2010

Funny Feeling

My registrar and I went to see a patient this morning. Normally we'd knock on his door, disrupt whatever he's doing and come to the interview room for a chat. But he was lying in bed this morning, and the nurse told us that he's been feeling weird since they gave him his olanzapine PRN.

"Are you feeling a little bit funny?" the Reg concerned, "yes, this feeling inside." Said the lethargic patient.

I almost burst out laughing to this reference to Elton's "Your Song", I had to bite my lips to contain the grin on my face. I would probably be the only one finding this hilarious.

It's probably nothing vicious, but we end up deciding that it's a ?chest pain, and did a full work up on him with serial ECGs and took some blood for troponin T as per suggested by the cardiology Reg. I dont think the patient find his feeling funny anymore.

Sunday, July 4, 2010

Death of a Fish

I have always been mindful of whats going on around the world, I don't pay much attention my immediate surroundings and is easily distractable, but I like to find out what's going on half way round the world. When I was a kid, we had to write diaries at school, and I remember writing about the political conflict between the two sides across the Taiwanese Strait. My teacher commented that I should pay more attention in class and study harder rather than worry about things that don't concern me. I should've replied that she should spend more time worrying about encouraging students rather than stifling their rising passions. Anyway, I am a bit of a greenie tree hugger too, and the combination of the two sees me sitting at wedding tables refusing to eat shark fin soup for conservation reasons, to the Chinese elders sitting across the table, I stick out like a sore inflamed thumb.

Apart from electronics, weird-ass TV shows, and Hello Kitty; the Japanese have also huge contributions to endangered species, particularly whales and bluefin tuna. They defend their actions with staunch argument of 'tradition' which, if you know the actual story, is distorted.

Whilst reading an article about tuna overfishing, Tuna's End, it collided with my own experience and resonated with concerns that left me toss-n-turning in my bed last night. The very first thing that impressed me was the size and shape of these magnificent fish. Contained within the stream-lined, olive shaped hard-shell skin are warm-blooded powerful muscles that propel at up to 60km/hr. They migrate over 11,000 km across the Pacific, making return trips from the coasts of America to Asia. They can grow up to 2 meters long and weigh up to 300kg.

"...the animal also has attributes that make its evolutionary appearance seem almost deus ex machina, or rather machina ex deo — a machine from God. How else could a fish develop a sextantlike “pineal window” in the top of its head that scientists say enables it to navigate over thousands of miles? How else could a fish develop a propulsion system whereby a whip-thin crescent tail vibrates at fantastic speeds, shooting the bluefin forward at speeds that can reach 40 miles an hour? And how else would a fish appear within a mostly coldblooded phylum that can use its metabolic heat to raise its body temperature far above that of the surrounding water, allowing it to traverse the frigid seas of the subarctic?"

I was first introduced about the matter from a documentary on Discovery channel, and while on GP placement in Pt. Lincoln, I had the opportunity to go see a harvest at a bluefin tuna farm. The word farm is more of an euphemism for slaughter cage. Remember the Tripod machines from the movie War of the World? They had cage/basket that were used to hold humans that are then consumed as food? That's what a tuna farm is. Each year, boats go out into the Southern Pacific to capture their tuna stock, once a sizable school (up to a few thousand fish) is found with spotting plane, the boats deploy a net that encircle the whole school like a cup of grains in the palm of your hands. The nets are then attach to a huge floating ring about 20 meters in diameter, and the whole thing is towed back closer to the port. Two problems here: first, the net captures all generations, young tuna don't have a chance to mature (which can take 5 years) and breed (depleting fish stock); and secondly, it takes about 15 pounds of feed to gain 1 pound of meat, the feed-conversion is so poor that it doesn't take half of your right brain to know it's not efficient nor sustainable. The Hansels and Gretels in the tuna rings never grow to the size of their wild counter parts.

"Afterward, they will be slaughtered and sent to Japan, where 80 percent of the world’s Atlantic bluefin tuna are eaten with oblivion."

Before 1800, Japanese tuna sushi didn't even exist. Occassionally tuna would find their way onto a sushi plate as 'shibi'(literally meaning 4 days - the amount of time chefs would bury them in soy sauce to mellow their bloody taste). "Fish with red flesh were looked down on in Japan as low-class food, and white fish were much preferred" according to the 2007 book "The story of sushi", by Trevor Corson. It was not until 1930s that tuna were commonplace in Japan. In 1950s, the post-war nutrient-scarce Japan saw tuna as an important protein source; this is the same time that Japanese turned on whales as food. It was not common practice to eat whales before then. What tradition? It was not until 1970 that bluefin tuna were regarded as a favored dish.

"..is there any rational argument for humans to eat bluefin tuna, wild, ranched or farmed? Is the fish really so special that no substitute will do? If the Japanese adapted to a higher-fat diet in half a century, could they and all sushi lovers not shift gears again and adapt to a sustainable diet?"

From 1976 to 2006 the worldwide population of bluefin tuna plummeted by 90%. Tuna are mostly caught outside the EEZs (exclusive economic zone is a stretch of 200 nautical miles of sea out from a country's coastline, that is usually regulated by its jurisdiction), which means very little regulations, if at all. The International Commission for the Conservation of Atlantic Tuna (ICCAT) is a body meant to set the catch-limit annually, unfortunately it does little more than pimping the fate of tuna to the highest bidder. "Even though scientific advice says you should stick to a specific catch number, in order to negotiate a deal, they tend to nudge that number over a little bit", said a former chairman of the scientific committee. In 2008, ICCAT set Atlantic bluefin catch limits that were nearly double what its own scientists recommended.

The issue with these noble fish is not only their imminent distinction, as tuna is one of the top predator in the food-chain, the disruption to the ecosystem of the sea is as serious as taking sharks out. To sum up my rant on the ignorance of humanity, Paul Greenburg, author of Tuna's End wrote a perfect parting reflection.

"Applying more pressure, I felt the needle slide into the flank, felt the resistance of the dense sushi flesh, raw and red and most certainly delicious. But for the first time in my life I felt tuna flesh for what it was: a living, perfect expression of a miraculous adaptation. An adaptation that allows bluefin to cross oceans at the speed of a battleship. An adaptation that should be savored in its own right as the most miraculous engine of a most miraculous animal, not as food."

Tuesday, June 29, 2010

Borderline

I saw a patient last Friday who I swear was a schizophrenic. She had voices in her head telling her to stab her family and herself, she was depressed, psychomotor retarded, she'd space out as we talk, very blunt affect. I thought she was classic schizoaffective with depression. I looked over her notes and couldn't understand why she was labelled with borderline personality.

Today I interviewed her again with my RMO, and my RMO picked her for borderline straight away. What did I miss?

I had picked up her auditory hallucinations and suicidal ideation thinking I've found the mother-load, and tunnel-visioned myself. As it was pointed out after, that her thought process was clearly not disorganised. Apart from her hallucinations, she had none of the symptoms of a schizophrenic (it helps that she's more talkative and happier today, but it still made me look like an idiot). I rang up her old hospital for a copy of her past admissions, she's had numerous suicide attempts, some of the lethality were questionable. Paracetamol won't kill unless you have taken enough; saying you have Over-Dosed when there's nothing to be found in the blood can't really kill you either. She's also trialled numerous antipsychotics, including clozapine, to no effect.

I realised that she is not psychotic at all. I've been fooled by her alleged list of symptoms. To my comfort, there were other doctors that thought she was schizo as well, which explained all the anti-psychotics that she was put on. She was probably not being factitious, but still, I was annoyed with her fooling me. So I looked up borderline personality disorder to educate myself.

Biggest clue for these patients are repeated suicide attempts (or some form of self harm). 50-70% of them had history of being sexually assaulted. I did read that in her notes, and she started to present to the hospital some short time afterwards. I started to feel really bad for her. She's never had a romantic relationship, chronically depressed, went through ECT, she was a cutter...she eventually reported the sexual assault to authority, the offender (who was family) became alcoholic and died 2 years ago, so she feels exceedingly guilty...the social history is a mess...

And it doesn't help that I can identify quite a few of the symptoms myself.

Saturday, June 26, 2010

Don't be a douchebag, take your caffeine

"if you choose to drink decaf, you deserve bad coffee"

Talking to a long 'lost' friend this afternoon, E, she clarified some of my misguided conceptions about coffee. She was lost because E spent a good deal of several months in the snow-covered Canada last year and thus off of my friendar (friend radar). She worked as a travelling coffee barrista much like a Gypsy fortune teller. One can go to a Gypsy to have their fortune told, but if you cross with one, you get cursed with bad Gypsy ju-ju. If you cross with her, you get served with black sludge, literally.

It started with questions about my sanity and my attempts to cover-up the fact that I am actually an emotionally damaged emo kid. But my misconception was that a cup of latte is 50% milk and 50% coffee, and that it shouldn't be foamy like a cappuccino wannabe. But then I found out that there are rarely that much coffee in an actual cup of coffee. You get 2 shots of espresso usually, so around 60mL.

Cappuccino is suppose to be 50/50, so it seems stronger.
Latte has a lot more milk but less foam.
Flat white has only a thin top layer of foam to seal it but rest is milk.

Which brings the question of, if most of my coffee is milk, what different does coffee bean make? Referring to people being fussy about their coffee beans. It doesn't really, unless you drink black coffee and black sludge. That's where fresh press coffee differs from a month-old coffee bean (it sounds more like a description for babies, "can you use some month-old baby beans in my coffee please?").

"What's sludge?" I asked. "Brewed coffee that sits on the burner for too long."
"Oh," I paused "and you can sell that?" She grinned electronically with mathematical symbols, "only when I'm feeling bitchy. Usually to decaf drinkers. If you choose to drink decaf, you deserve bad coffee." She went on to explain how most decaf drinkers act real douchenozzle like.

The word sludge though, reminded me of a case I heard about on the psych ward. The logic is that a man wanted to commit suicide. He heard that if there are bacteria in the blood, it can cause septicaemia which could lead to multi-organ failure and death. He also learned from school that there are bacteria in poo. You put the two together, that is what he did. He injected poo into his blood stream, unfortunately his plan didn't succeed.

Initially it was puzzling for the treating doctor as to why they found E. coli in the blood, and then some curious intern found the 'concoction' in his drawer. Subsequently it was learned that he is usually discharged for this malingering behaviour, so he travels across country, gets admitted to hospitals that his fame has not reached.

When they rang up a hospital inter-state for previous medical record, they said "oh! you guys found the poo-pusher!?"

Thursday, June 24, 2010

Portfolio

One of the hurdles we have to jump is to write a portfolio for the school. A thousand-word how-does-that-make-you-feel essay about life in medicine from the perspective of a student. Then we have to talk to our assigned 'mentor' about it for half an hour or so. An assigned mentor is like an arranged marriage with an ugly woman with no sexual desires. You don't like her and she doesn't like you. Nevertheless, after 2 hours of pouring my hearts out on paper, I consider my portfolio a literary achievement. One that is so inspiring, thought-provoking and yet humourous, all in the context of fulfilling a mindless task of a ticking-the-box hurdle. All written in 2 hours.

I met up with my mentor today, and it is obvious that he had a glance through my words. Just a glance. If i put two hours of my time into something, I want someone to at least read it. So here is some extracts:

What have you noticed about work pattern and work practices in medicine? What effect do you think these have on doctors?
I have thus far completed paediatric, obstetrics and gynaecology rotation, rural GP placement and finishing my urban GP practice. I am on psychiatry rotation at the moment. I have spotted that different specialities have very different cultures, practices and thus much different timetable and lifestyle for the doctors. I understand that lifestyle is as much a factor in influencing an individual’s choice in specialty as personal interest, if not valued more sometimes.

Generally the life of a doctor at the hospital compose of ward rounds in the morning, arriving earlier the more junior you are; frantically recording all the instructions and jotting down sparse threads of knowledge that slip off of the Consultant’s tongue. Depending on the specialty and ward, this could be done by early morning, in time for a shot of caffeine, or ongoing till your stomach groans louder than the patient writhing in pain. You divide the rest of your day between carrying out instructions on the ward, visiting clinics and sometimes ED, and wait by the phone for the radiologist to call back. Variations are specific to the specialty, your seniority, and of course, your competency. As a consultant, there are commitments to private patients. A registrar gets peppered with stupid questions from worried interns from another specialty. RMOs get to scare medical students who are following them around like puppies. And interns busy pulling their hair out over their newfound responsibilities and overwhelming work.

Being a medical student amongst all the chaos is the most contradicting experience. On the one hand, nobody expects you to know how to do anything save the most basic history and physical examinations; on the other hand, you better have an answer for the question thrown at you by the consultant with a glare. Everyone expects you to commit as much time on the ward as the patients themselves, leaving no time to study; yet also interrogate why you have not read up on the topics you were quizzed the previous day.

Different specialties require different demands based on the nature of work, and these effects are clearly demonstrated by the doctors who work in the specialty. Paediatricians like psychiatrists are very soft spoken, as if not to spook the patients. Both specialties require endless patience. Added to the playfulness, paediatricians can also make opportunistic diagnosis while cooing a crying baby or calming a child tantrum. Psychiatrists are meticulously observational and insightful; and like obstetricians and gynaecologists, they inspire trust and rapport rapidly with patients.

What kind of work stresses exist in medicine? (what kind of stupid question is that?)
All jobs come with a description of stress, with some more than the others. A physician’s work is especially stressful, for we are always trying to practice beneficence.

At my GP rotation, I found that the sheer amount of patients walking through the door can leave a doctor eating lunch at 3pm. Yet GPs are always trying to spend more time with each patient. So there is a constant time pressure. In paediatrics, stress comes from not only the patients but also the parents, as a paediatrician attempts to treat a family rather than a small sized human. In obstetrics and gynaecology, the most stressful situation is seeing a PPH in action. Never in the field of medicine have I seen so much blood pouring out so quickly with so few warnings. The first time I saw one drained the colour off of the patient’s face, and mine. In psychiatry, the traumatic experiences, social issues, and transference contribute to significant emotional stress.

On top of the specialty stressors, there are always the basic stresses over medical stability of patient, misdiagnosis, and general concern for the outcome of the patient. True to most doctors, but more particularly for a medical student; there is the added stress of studying, or the more troubling, the lack of. This is especially relevant for a third year student. Given the chance and time, I would love to spend as much time on the wards and see as many patients and learn as much as I can, but the looming end-of-year exam means that I have to excuse myself from clinical settings. Sometimes the lack of understanding consequent the biggest stress for me as a student.

Tuesday, June 22, 2010

Vicious Cycles

Life is fairly consequential. Often the reactions loop back and link up with the actions, forming circles, so life is full of circles. Problem is that some circles turn into vicious cycles that, like maelstrom, suck us down and we cannot escape despite all our efforts.

We saw a young pregnant lady this morning, who had quite a lot on her plate. We saw her for the panic disorder, but the medical problems that she is dealing with took pages and pages to summarise.

Her chronic anxiety lead to avoidance and sensitisation which feed into fear of future panic attacks. Avoidance develop into agrophobia, plus the sensitisation finally becomes panic disorder, which accentuate to chronic anxiety.

When she's anxious, she smokes cigarette, which compromise airway, lead to use of nebuliser (ventolin) that produce symptoms like palpitations that mimic her panic attack, increase her anxiety.

She has gastroparesis which lead to constipation, chronic abdo pain which is accentuated by the panic disorder. She abuses codeine and NSAIDs to control the pain, which reduce bowel movement, lead to more small bowel obstruction, lead to more pain and thus more morphine, slows bowel further, but also lead to addiction and tolerance, so she needs increased dose of morphine use, more constipation, more pain. Downward spiral.

She gets stressed by her panic disorder, so she abuses cannabis (THC), opioid, and was given valium (BZD), developed dependence on all of them, which lead to more stress as she knows she's addicted...

Because of all this on her plate, she has only recently stopped her cigarette and THC a month ago, and possibly still using opioid. She is now 36 weeks, the damage for the fetus has already been done. When the child is born it is likely to have congenital problems, which means more issues for her, who already has 2 children, no job, left school at 15, etc etc. Her parent were young as well, mum was 18 and dad was 16 when they had her.

How will she ever escape?

Friday, June 18, 2010

Madness of King George III

Cardio: Tachycardia and arrhythmia.
GI: Acute abdo pain, vomiting, diarrhoea or sometimes constipation.
Renal: purple urine.
Neuro: seizure, neuropathic pain.

The patient suffers from acute prophyria. To help with memory, I found an old film about it. Following are some memorable lines from the movie Madness of King George:

"Do you think that you are mad?
I don't know
I don't know
Madness isn't such torment
Madness isn't half blind
Madmen can stand
They skip. They dance
And I talk. I talk and talk and talk
I hear the words, so I have to speak them
I have to empty my head of the words
Something has happened
Something is not right."

"Yeah, I've always been myself, even when I was ill.
Only now I seem myself. And that's the important thing.
I have remembered how to seem."

Poor King George suffered the attacks some 100 years before the disease is recognised by the medical profession.

Tuesday, June 15, 2010

The Fallen

She is only 51, but she looks much much older, in her 80s or 90s. She's frail, skin and bone, sunken eyes and hollow cheeks. She looks like she has one foot in the grave, or just climbed up from 6 feet under. Her fragile frame, gnarly claws, and unsteady gait, reminds me of the de-conditioned black-and-white survivors filed out of WWII concentration camps.

She speaks slowly, but her stares are still sharp and she glares at us for admitting her to the psych ward. She is angry, "I want to go home," she said. "Why am I here?" Her daughter shakes her head and tuts in agreement.

She was a GP not half a decade ago, her license was revoked after she suffered a stroke. The sense of gloom and doom were so great that she became suicidal since her loss. She's given up. She spent the next couple of years contemplating about it, managed to convinced everyone around her that is the way to go, even involving 2 GPs who are now being reviewed for their medical ethical decision. She has literally starved herself of food, of hope, and of life.

She was a medical student once, a breed very much familiar to me. I can imagine her being a perfectionist, particular and highly functional; could handle anything that is thrown her way, and deals with everything herself. Her meaning of life was robbed from her when she had the stroke, she can not tolerate functioning at any level less than the highest.

What really strikes me is that she had given up so quickly and easily. Because I am exactly like that.

The "Stubborn Child Law"

In 1946, The Stubborn Child Law was enacted by Puritans in the Massachusetts Bay Colony - Parents claiming a child was stubborn or rebellious could seek State reprimands, including execution...And I thought Asian parents were bad...

Sunday, June 6, 2010

Music logic

I have never been good with words. Other than the obvious suspicion of expressive language disorder, the real annoyance is that I am left with whole heap of theories and points that I find hard to express or formulate into words.

One of them is my theory of music logic.

I believe that just like normal logic, there's a grammar-like rule that helps us understand music, or "complex non-linguistic auditory signals". Our preference of music depends very much on these music logic. We all find some music mollifying and others utter noise, and according to my music logic theory, some music 'makes sense' to us while others do not. Obviously the type of music that makes sense will appear much more soothing and resonate stronger with us.

Music logic allow us to listen to a piece of music, 'agree' to its melody and 'predict' what is coming up. Like when you are in tune with someone's thought process, you can finish their sentence. The harmony between the music and our intrinsic music logic means that we find the piece very favourable to our brains.

I believe that the music logic as I call it can be learned like grammar of a language. So when we are exposed to a new piece or new type of music that we have not previously heard or enjoy, we may resist it at first. But as more exposure and repetition drum it into us, the new logic may stick and starts to 'make sense', consequently become enjoyable.

I have based this thinking on my own experience where, I have only been exposed to classical music as a kid, then old mushy 70s, 80s love songs, and rock in late teen years. Each time it took a while to make the transit, but once 'understood' I enjoyed the genre fully.

I am sure there is a term already coined for this 'music logic', if anyone well-versed with music theory know what it is called, please let me know.

Tuesday, June 1, 2010

The Asian version of my name

I've been asked quite a lot recently whether my name is really Shawn.

The latest was yesterday, the first day on my psychiatric ward.

I introduced myself to the Registrar on the ward. She was very friendly and took me aside to give me a brief introduction and what to expect. "A lot of students find psychiatry very daunting at first," she reassured me, "but over time you will learn how to deal with patients, don't worry." After her spiel she proceeded to put my name down on her note pad, just to confirm though, she asked, "what is your name again?"

"Shawn"
"is that your real name?"
"huh?"
"Oh, because most Chinese students and doctors on the ward have Asian versions. Is Shawn your actual name?"

I was tempted to tell her that Shawn is actually my alias for Mon, Wed and Thursdays. I go by a different name at night and also respond to the name Bon Jovi when I've had a few. I am also actually a jaundiced Caucasian. But then I was reminded that we are about 10 meters away from a closed psych ward and that she is a psych registrar. She can have me detained for 24 hours with one signature.

I did not mess with her.

The Son of God

We have just started 2 days of psychiatry, its been crazy so far (Hah! get the slightly inappropriate yet still mildly funny pun?). I have been thrown into the deep end, 5J the closed ward in Margret Tobin Centre, literally the maximum security, ultimate psychotic ward. I met the Son of God today, and he's been preaching to others on the ward. It's only a matter of time before I'm converted, and then I can finally use the excuse, 'it's against my religion to work/study'. I may have to help him write the bible to his new religion, because among his early followers my hand writing may be the only one legible. I cant wait to meet Moses and Joan of Arc, although I don't speak French, I'm sure I can understand her just fine.

There are of course no Joan on the ward atm, but there is a nasty mean lady that shouts, "go back to your country!" everytime I walk pass. It's apparently not professional to play into patient's delusions, so I will have to wait till my last day to tell her that actually, my country has bought the majority of Australia and she will soon be deported to Uzbekistan.

So as I walk around in my shirt w/o a tie, a duress/rape alarm clipped to my belt, and escorted by a macho man-nurse and 2 fat donut-filled security guards, I cant help but feel slightly sorry for the patients. Most of them have a theory and lives in an alternate universe of their own. They are labelled as delusional and psychotic because their realities are different to the one we are used to. Their perceptions of the world deviated from our perceptions, but who is to know that our perception fits perfectly to the actual real world? It's like looking for something with a small torchlight in pitch dark, what we see is limited to the little cone of light. I am sure our torches doesn't illuminate the whole room either. One day, when the absolute Truth is revealed, we will learn that actually, 42 is not the answer.

I will have to find something else to tatoo on my bum.

I exhausted my booze money on a ticket to Slash concert in August in Melbourne :p cant wait. I'm now living on my drugs money. Oh and the first day on Psych ward, I learned how to make hash brownies from the consultant :) Who knew I'd learn something useful on the wards?

Thursday, May 27, 2010

Shawn the Pirate

It shits me to no ends when I meet a racist.

A patient came in to have his monthly BP check up as he's hypertensive. it came back high on the automatic BP machine, I checked it manually for him just to make sure, after my little spiel of the distrust for BP machine. There was nothing else to do for him except making small talk till R comes back in the room.

Then R came back in and they had a little chat about family problems, etc. So his son has mental problems and cant get a job cause he has no qualifications, etc. It became apparent that it is MY fault because people like me comes to Australia and takes all the jobs. It's a huge problem.

Ever considered if the job was done well by an aussie, I wont have a chance to get it? And what does it matter if a foreigner comes to take a job in Australia? it increases GDP no matter who is on the job, and the individual lives and shops in Australia, raise family...

Not only am I stealing your job, I'm also taking your women, plunder your villages, slave your young and burn everything to ground. YAAARRRR!!!

I am probably going to get a comment from some Scandinavian telling me that it's wrong for an Asian to act like a Viking.

Wednesday, May 26, 2010

Jabba the Hut

You could smell the odour across the hall, a mix of muskiness and sweaty a-showerness. R poped out for a quick break, so he left me in charge and told me to see the patient.

It took the patient a good few seconds to gather enough strength to prop himself up from the chair and walk a few steps into the consultation room. He weighs more than 200kg, supports himself with two walking canes. He came in and plunk himself in the chair, relief from all that work. He told me that he is having atrial fibrillation, my eyes widen and my brow cringed.

"you are having AF? right now?!"
"yea, feel my pulse"

He's not joking, his pulses are irregularly irregular; it speeds up and slow down, weak and strong. My face goes pale. Lets hook you up to an ECG.

He has no chest pain, no dizziness, no claudication (he walks no more than 20 meters anyway), or ankle oedema. But he is short of breath (although he didnt seem too distressed, RR about 16), which severely limits his mobility. His palpitations worry me. He looks clamy and sweaty, no good.

The ECG showed first degree AV block (normal QRS, and a P for every QRS, but totally random PR intervals). Since its irregularly irregular you cant calculate the HR from PR interval, panicked, but then I remembered you can count the QRSs in 5 mins on a strip and work it out. I took the BP which was surprising low. HR 96 and BP 115/70, what is going on?

Whilst we are waiting for R to come back, he started telling me about all the cardiac drugs that he's been on. he complained how digitalis is limiting his exercise capacity, how spironolactone gave him man boobs, shrank his penis and reduced his libido. It suddenly reminded me of Jabba the Hut and his scantly clad slaves. his stomach drops as low as half way down his thigh, it'd be a mission to get all that fat out of the way to have sex.

When we are finally done and went back to the consultation room, R is as stoic as usual, so is the patient. The patient only wanted to find out if it is ok to go off one of his meds (among the long list that he has), and asked for a script which was promptly filled.

None of the palpitations nor SOB or AV block phased anyone, I was the only one freaked out and did a full cardio exam and ECG. But what do I know really?

Surgical Fetish

You can have a long day without having a long day, and today was one of those days. Coming home from the clinic we were all totally drained, I soon collapsed after dinner like a lung in pneumothorax, and napped a bit before bed. It wasn't that busy at the clinic today, but I certainly did saw some interesting things and got to do a few practical things.

A lady with suspected stroke in the morning. My GP was rather concerned cause he was chasing up the CT results in between every patient, so I asked about the onset thinking he's probably pressing time to push that tPA (thrombolytic that can only be used in ischaemic stroke within 3 hours of onset). Much to my surprise, he's not waiting to administer tPA. In the country, due to logistic reasons, they do no give tPA simply because a CT within 3 hours of onset of a stroke is not likely to happen. A shocking difference between country medical practice and stroke-unit equipped hospitals.

Tuesday afternoon is RoSL (Removal of skin lesions) time for my GP, I had asked him eagerly for permission to do some yesterday, and my stoic GP dismissed me with his usual impatient nod, any yes is a yes and I will take it. I am always very excited when I get to cut people (if you are reading this following a google search hoping to find some cutting fetish then I am sorry, this is not one of those. For cult membership, please email me to arrange for a meeting back alley). I have so far manage to cut out 2 skin lesions (2 BCCs, one on my own) and was eager to claim more scars under my scalpel.

My GP (R is the name) does things quite differently to what I am used to. For one, if the lesion can be cut out with a puncture biopsy knife, then he's more than happy to take it out in one go. It's fast, but without the tails of the conventional wedge, it's a bit harder to stitch, and I am not sure if the scars will be more prominent. Secondly, not only does he sandwich the lesion with local on either side, he goes under and through the lesion! His reasoning is that you can lift up the lesion with the needle a little and inject local under it. I am not sure if that is a good idea as it may puncture the lesion, it is faster, but I am not sure if it is a shortcut I'm comfortable taking. Lastly, he cuts the lesion with very small if any margins. He usually just circle the lesion and cut along the circle. No 'eye of a tumor', I love the eyes of a tumor.

Picture of area of excision for melanoma

I helped cut out a melanoma on the nose, a huge one on the scalp (~2.5cm in diameter, 1.5-2cm raised, it's a ball on top of the head). I then got to cut a BCC on the shoulder and a haemangioma over the scapula. R watched me suture the shoulder incision, then a bleeding incision on the face. He must have gained some confidence in me by this point (or that he wanted to go home early, which tends to happen quite a bit) cause he left me to stitch up the last patient on my own (with the practice nurse).

The patient had melanoma that was not completely cut out last week (without any safety margin, I am not surprised!!), and R ended up removing a skin tissue that is 4cm long and 2.5cm wide over his suprasternal notch. R had his last patient of the day waiting, so soon as he's done cutting, he left me with the gaping hole to be stitched up. It was the biggest wound that I have sutured to date. I placed a mattress suture in the middle to hold it together, then closed the rest with simple sutures. On hind sight, I should've placed more than one mattress. Nevertheless, the practice nurse thought I "did a great job", R thought it "beautiful", S (another GP who poped his head in to check if the treatment room was available just as I was finishing up) was impressed, and most of all I am happy with my work :)

Redundant Question

"Books are written by those who have nothing better to do" - Gynae Prof.

On the same token, Guidelines are probably made up by those who had even less to do. They are useful in some situations, but definitely not the most practical things. The mnemonics are great for quick recall of what prompting questions need to be asked, but you wont always get to the bottom of your mnemonic though.

I had a patient come in today with chronic lower back pain (20 years) that drives him absolutely up the wall and depressed. Pain killers does little for him, and he doesn't believe in the value of antidepressants. He's come in with a shoulder pain that's been brewing for over a month, and said all the pain has made him suicidal. Alarm bell rang in my head. Since he has the ideation, I need to ask about plan, and lethality if any. So I explained that I ask every suicidal patient whether they have a plan.

He squinted his eyes and whispered under his breath,
"I don't need a plan."
"huh?"
"I was trained as a sniper in the army, and we were trained so that if we ever fall in enemy hands, there'd be no live snipers to answer questions. So I've been trained to kill myself."

He then went on to tell me how he can weaponise my pen in my front pocket, the glass on my watch, his watch, my stethoscope, and several innocent objects in the room.

I was gonna ask if he had the means to carry out the plan (e.g. like a gun in the house or something), but I thought that was redundant.

Thursday, May 20, 2010

Patient Confidence




Sitting at a cafe by the waterfront in the morning is quite a luxury. A lone rusty boat anchored a stone-throw off the sandy beach, buoying up and down with the waves. The wooden jetty lies alongside the boat keeping each other company. The lavender-turquoise coloured azure wash-painted on top of the deep indigo blue-green background fabric, carelessly brushed into a vague horizon. The flaring ball of fire reflecting off the morning dew on the tips of grass blades, unthawing the morning mist and my frozen limbs. The sea, the harsh mistress, is feeling tranquil this morning, not a line of white wrinkle on her blue blue cheek.

Note: I forgot to bring my camera, stupid me.

Albeit the plain foamy latte (Eugh), I was feeling ready for the 4th day at the rural GP practice. The previous few days had me prepared, always prepared to call for help: “I think this is what is happening, but let’s call the doctor back in the room and see what he thinks”. Not this morning, my confidence was about to take a huge wedgie from the meanest kid in town and then hang upside down in a bin rolling down a steep street. The first course was a lady who came in for scripts, just before she left, she asked if her seborrhoeic keratosis and a sizable haemangioma need to be cut out, they were annoying as they get caught by bra strap and get itchy. “they are benign and don’t need to be excised, but if its causing you grief, we can do it for you”. As always my enthusiasm took the better of me, and I volunteered eagerly as I’ve been dying to do something hands on. Plus I think I did a pretty good job on the last two that I’ve done. “What am I, your guinea pig now?” “Will it hurt?” she had a serious look of do-you-know-what-you’re-doing on her trusting face, “I should come back in a couple weeks time when you are not here”. I backed down and said no more. Before she left she said “I will try and book a time next week so you can practice”, I replied “you don’t have to”.

The next patient looked like an old sea captain. After my GP introduced me as Shawn the med student, his widened eyes stared at me in disbelief as if I was a ghost. In a way I was as foreign to his mind as a ghost. Because he lifted his walking cane, pointed it at me and in an astonished tone gasped to his wife, “Does he look like an English person to you? Your name is Shawn? You don’t look bloody like an English, you are an Asian, why is your name Shawn? Where are you from?” Quite taken aback by how rude he is, I didn’t know what to say, I had seen nothing like it. He ranted on for another minute or two, and every so often during the consultation, he’d confront me with his stares questioning my purpose in that room. I can’t very well remember the rest of consultation or the two that followed because my mind had blanked out. It was awkward and I must have looked quite shocked, because his wife was rather embarrassed and started making small talks with me, the rest blurred.

There are more than 1.5 billion of us on the face of this planet, grandpa.

I must have been sensitised because throughout the afternoon I’d noticed people’s reactions when I go to the patient waiting area to call patients in, I had patients question my ability to give flu shots twice, and were told that last time a student did it, he bled all over his shirt. It’s a simple IM shot, a blind-folded monkey (me) could do it, and the monkey did it 12 times yesterday you jerks! Yesterday a woman was giving reviews of the doctors she’d seen at the hospital, “Dr. So-and-so was excellent, he couldn’t get an operating theatre for me, but by the end of the day, he was so apologetic that he came around to see me and told the nurses to get the poor lady some food (she’d been fasting all day). Dr. Blah was pretty good too, I liked him. But I don’t like the Asian doctor, he couldn’t get blood off me arm, and had to use an ultrasound to get the needle in the right place...” She had the BMI of at least 40, if angels were to be banished from the sky, she’d be it, for the sin of gluttony, and the skin folds draped down on her back could be mistaken for wings anyday. She remembered other doctors by name, but the Asian doctor by his colour.

note: I took the blood of an obese lady successfully in first go at the end of the day, small victory.

There's something about me that doesn't inspire much confidence in patients. I don’t have much confidence in myself most days. Patients take one look at you and those splits of seconds decide how much they confide in you. Country folks being honest and frank they are, definitely let you know about it.

If I meet another person that judges my competency by my skin pigmentation, I’m gonna fucking lose it...

Tuesday, May 18, 2010

First day

Nothing says it's my first day better than turning up late to the clinic because you were lost. No in a town no bigger than 13k people, you cant get lost in the maze of streets, or blame it on traffic jam. We did have a legitimate reason for being late, albeit a rather stupid one. We went to the wrong clinic.

We got up early, dressed and had breakfast, ready for the first day at the medical centre. Two weeks of rural GPing starts here. We drove down the road, following the iPhone instructions and found the place easily. We went in, introduced ourselves, sat down and start to admire the brand new building, the size of the practice, and how busy it is for a rural practice for a good 15 minutes. Then a lady came to introduce herself, explaining that she's coordinator of the place and they weren't expecting 3 medical students from Flinders..they had spent the past 15 minutes calling their contacts trying to figure out who we were and why we were there. It didn't take long to figure out that the person we've been in contact with is located in another medical centre, and we were given the right direction to get there. Phew. I didn't make the same mistake for the rest of the day, and chop the wrong leg off of the wrong person. I wanted to.

It was a good day nevertheless, the GPs are welcoming, the pharma rep brought hot lunch, the receptionists are nice, and the nurse let me jab someone with Fluvax with promise of more needlework tomorrow.

My GP is the most laid back doctor ever. He asked me if I wanted to do any work for this two weeks, or if I just wanted a nice holiday. "some people come here for holiday, and you guys have to study throughout the whole year anyway, I wouldn't mind." How understanding! I managed to catch a yes from him for letting me consult some patients and minor surgeries tomorrow as he was running out the door at 2pm in the afternoon having finished for the day.

Tomorrow will be awesomer :)

Sunday, May 16, 2010

Rural Adventure

There is something magical about road trips. Perhaps out of the inevitable and overpowered by excitement over the destination, they are generally considered as exciting and fun-filled. Normally, it is not an appealing idea for 3 grown men to squeeze into a smallish car filled to the brim with bags and personal belongings so that it takes considerable work to move one's little finger, throwing in 9 hours of bad singing, bladder stretching and outback scenery (which gets dry really quickly). Other than the obvious option of playing all the rock ballads from the 70s to today, and shout along with it. There's also sleeping, snoring, snacking and mooning oncoming car (which we certainly did not do but is a good option nonetheless), if you are not the driver of course. When you are the driver, you have the bonus option of swerve driving to get that small animal dodging cars on the road.

It is also one of the best time to check your taste in music with your traveling companions. It's a bit like being the first to say 'I love you' in a relationship, you play that song on your iPod, curious to see the reaction of others. It could be met by raw blatant enthusiasm, or awkward silence and looking out the window. Your guilty pleasure is not ratified by others' confession, Kelly Clarkson is still too girly for a bloke. But only under the perilous conditions can true bonds of friendship form, especially after you have shared 20 minutes of epic opera-rap accompanied by bagpipe, organ and children choir. Its an actual song, I will link it 'morrow.

I had been excited about this rural placement for a few days. I like the coast better than inland, so being a port already scores positively with me. But not only that, Port Lincoln is considered the 'seafood capital of Australia'. My love for fresh seafood and the idea of study vacation plus time away from FMC were concocted into a delicious cocktail that two-sip-Shawn couldn't resist.

You probably don't ever need to bring that much stuff for two weeks away. Unless you are a chick. But for some reason, going on a rural placement feels like being sent to a distant post, you should be ready for everything that could be thrown at you (hopefully not a tuna), and so I made sure I was prepared for everything. Workout gear, PJs, work shirt, going out shirt in case our GPs take us out, T-shirts for looking casual and blend-in as not to attract hostile attention when we go to a local bar, while emphysising my taste in clothes thus repel bogans. Jeans, shorts, work pants..and since I've been warned about how cold it can get, I had my trusty trench coat so that the local paper may report sighting of Neo wondering about in the windy and miserable rain.

And God forbid, should the most unlikely scenario arise, that I should feel the urge to study, I will need books! as a consequence of foolish innocence (I never study on vacations, but I can always convince myself into lugging 10kg of books around), I have a small person library with me, taking up half of the space in my suitcase.

The drive would have been more interesting if we spotted a kangaroo on the roadside taking a dump, but we didn't. The vast plain although inspiring, one's awe centre in the brain can only remain stimulated for so long. In the same token, the symbolism of the long lonely highway, stretching as far as eyes can see, vanishing on the other side of the horizon off a tiny gap between the tree line, soon loses its deep and meaningfulness too.

We stopped by Port Pirie, Augusta, Cowell, never thought of topping up fuel. We almost ran out of fuel. I was excited about the idea of hunting kangaroos for survival until we can wave down another car passing by, which would've taken 5 years. It would just be like the movie Castaway, and I can grow an awesome Jesus beard. But JD pulled into Arno Bay (a town as small as a fake Western movie set) to look for petrol station. We spotted one pump that is on holiday until tomorrow morning. Desperate, we went into the supermarket in search of salvation and salvation we did find.

We asked the checkout lady about nearest petrol station, highly trained to deal with stupid tourists as she is, without saying a thing, she led us to the back of the shop and called for the comical old handy man who smiled his eyes into two lines of hyperbola. Much to our relief, he topped us up with some of his reserve, while recounting an earlier rescue of the same nature today. He knew there're no alternative source of petrol within our reach, he could've asked for a premium for those precious petrol, but he charged us the same amount he bought it for. He didn't ask questions, he didnt need to know who we were or where we are going, all he needed was that we were travelers in trouble and needed his help, thats all he needed. That is the spirit of country I think.

We arrived at Pt Lincoln by nightfall in one piece, exhausted but excited. We survived the trip.

Saturday, May 15, 2010

Inaugural Post


I have never had the habit of keeping a diary. Naturally the idea of a blog is unnatural for me, if I can't trust a book with the reflection of my inner self, why would I do it over the Internet? Nevertheless, due in part to curiosity of the novel and in part to practical reasons, here I am. Vedi, Veni.

Malancholy is my favourite word. In the dictionary, it is defined as: 1) a gloomy state of mind, especially when habitual or prolonged; depression. 2) sober thoughtful; pensive. 3) archaic meaning of having too much black bile, a condition considered to cause gloominess and depression in ancient and Medieval medicine. To me, it describes a state of being that is both slightly sad and happy at the same time; a hint of gloom but gladly so. No depressing downward dismal, nor vulgar ecstatic glee. It's like listening to Chopin when it's raining; like the drizzling light rain on a beautiful Sunny day; like a grey clouded sky overcasting a sea of calm waves, brewing the next storm. It represents the way that everything has in itself, two contradicting sides, existing simultaneously. War and peace; ying and yang; matter and anti-matter. Nothing black and white, all but a shade of grey.

I have always thought that happiness is like luck, or cash, you will eventually run out of it someday. Elated gaiety will not only exhaust your reserve like a shopping spree, cheeky exuberance simply attracts the jealousy of the Olympian Gods who will strike down in punishment. Therefore I have always been careful of being too happy, abiding to a life of Confucian modesty, and humble ignorant bliss. But it hasn't worked.

I spend my life in pursuit of significance. The importance of every action, the weight of every word, the meaning of every place. Without significance, it has no meaning and is not worth doing. I have thus become too careful to experiment, be free and spontaneous, and subsequently intensely boring. I blame it on having grown up reading about extraordinary people. At my age, Alexander the Great had conquered the Persian Empire, and was hailed as the King of Kings. Unfortunately I have never been significant myself. I am not special or unique in any way. I no taller, faster or stronger, just average. Oh how I hate the word mediocre!

Despite what Freud said, I am not crazy. And I do not wish to be tested.

If anyone shall stumble across this page, I hold no responsibility for offending anyone. Not even for the posts written specifically to offend people. I have a wacky sense of humour, so inevitably my amusement will bait me into writing stuff in the pretense of quality comedy. If you don't like what you read, go away. Real life characters and events recounted here may be regarded as urban legends should the need of disacknowledgement arises. And lastly for the boilerplate, the author remains the right to refuse any claims made on this page. Like waking up from your last pleasant colonoscopy experience with veins full of midazolam, you do not remember reading that.