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.

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.