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.

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.

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.

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...

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 :)

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.

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.