jogging an old memory

It's really bizarre how patients pop back into my mind when I revise for the exams. The scarier part is the fact that the patients that I recall tend to be the ones who are ermm, deceased.

Anyhow, the patient in focus tonight is this 50 odd years old man who presented with projectile vomiting and weight loss to the ED. I learnt tons from his illness as it turned out he had advanced gastric cancer.

It was the first time I
1. felt a succussion splash
2. palpated a Virchow's node
3. observed a total gastrectomy.
4. had to take an extremely complete history and examination as I was going to present him at the Surgical sessions.
5. had a patient die on me. (he died a few days after my surgical presentation)

I remembered after the gastrectomy, the surgical registrar was trying to suture back the midline laparotomy wound cautiously and carefully, through loose skin that had suffered the unduly fate of 30kg loss. The only distraction on the abdominal skin was this huge myraid of tatoos. She commented, "well, he's not going to have much to look forward to anymore, the least I could do is to make sure his tatoo matches back up and aligns."

Anyhow, now whenever I revise gastric cancer.. this poor chap pops back into my head.

I hope he's happy wherever he is.

i wished it was the holidays already.

I have done work.
But like nothing's sticking!.......

I'm so damn bored. help.

O&G = OVER & GONE!

I cannot begin to tell you how glad I am that today's exam was like 50% repeated questions. PHEW. We had 6 stations and I only fumbled in one of them.

and that one station.

I.. had the same examiner from Wednesday.

OMG. the humiliation! I thought I would never have to see or speak to him ever again.
The first thing he said to me was..

"ok Daphne, let's see what you know."

Daphne's mind: nothing much, since you are examining me.

A series of tiny ultrasound scans with some grey dots and white dots.
o.O Obviously I wouldn't know what it is.

The questions were not too bad but I kept having this vibe that he still think I'm a dumb twerp or something. sigh. looks like first impressions really stick huh.

Anyhows, we have a wonderful dinner at FARINA!
A very long list of cocktails to choose from and the tapas were delicious... *drools*
I had a fruity girly one, and one that can knock the ghost out of anyone i'd reckon.
wheeee.

I'm so glad o&g is over.

OVER AND GONE.

the rubbish test called a viva.

The O&G viva must have been one of the most traumatising exam experience I have ever had in my ENTIRE schooling life.

Thankfully I passed, others were not so lucky.
Yes I admit that there were some student factors that I could improve on for future examinations but I have MANY MANY grievances towards the setup, patient choice and examiner choice for the viva.

1. My stupid patient's main problem was NOT related to obstetrics OR gynaecology.
She was under-going freaking chemotherapy for a large B cell lymphoma and was thus taken OFF hormone replacement therapy. So when I asked her why she was here, she was in her own words

"oh, just wondering if I could get restarted on that HRT"

Where was I supposed to go from there?
I assessed her suitability for HRT (heart disease, liver disease, breast cancer etc etc)
and asked her if she previously had side effects from HRT.. etc etc.

And after I presented the case to the examiner, his first comment was

"why did you not palpate for ALL the lymph nodes in her body, especially since you knew she has lymphoma?"

GAWD. In my defence, I did palpate those in her neck and axilla cause I freaking examined her breasts. But seriously, A full body workup for her?

The day before, most of the students got obstetrics patients with REAL obstetrics problems.

2. Stupid Examiners
Please choose examiners that are not L-field, extremists who do not believe in the SA Perinatal Guidelines. I mean, why else do people develop guidelines then?

Whilst being quizzed on cord prolapse..
I mentioned ALL the damn measures in the guidelines.

Examiner frowned, and said "where did you learn that from? Your patient's baby is dead"
Me: perinatal guidelines
Examiner: Do not believe everything you read young girl.

Also, please choose examiners who have a patent and working auditory pathway.

I had to repeat my surgical procedure for a Bartholin's abscess like 500 TIMES. (and PS: everyone knows how loud i speak)

Examiner: so what is the name of the procedure?
Me: Marsupialisation
Examiner: so you have incision, excision, what else?
Me: Marsupialisation..
.
.
.
.
.
I WAS GETTING FREAKING ANNOYED
Examiner: ok, one last chance, it has something to do with Australia's favourite animal.
Me: MARSUPIALLLLLLLLLLLLLLLLLLLLL.
Examiner: YES! you got it. good.

FREAKING hell.

gahh.

heatwave...approaching?

You see, I come from the land afar called SINGAPORE.
Singapore is humid, sticky, warm with some months going bonkers where it rains NON stop and umbrellas are useless creations.

So you know, I'm not that unfeeling towards bad weather.

BUT seriously, the HEAT in adelaide can fry flies! and dry out eyeballs.
oh gawd.
if we have to go through with the heat wave again this summer, i will perish. along with the other thousands of fried flies.

We usually have our exams in mid november when it can be warm and summery again. BUT this year it is at the END of november.

say hello to heat.

oh gawd i hate this.
grrrrrr.

the thing called yoville.

since i spent so much of my time moving furniture around.
i might as well show the world how my virtual apartment looks like huh.
i'm pretty happy with the living room
but the bedroom.. hmm i like the cozy sofa corner. but i need to do something about the bed. looks wrong.
oh wells.

i feel like it's super swot already.

I realised I am going to be cooped up at home for like what, the next 6 weeks? GAWD.

O&G is coming along slowly but surely.
Lots of crap to cover.

No more weird baking.
Don't think we are getting the funky duster.
Even Yoville seems abit boring already.

I need a new distraction!.. ok one that you can (hopefully) do for like 10 minutes in between studying just to chill the brain out. Any recommendations? lol.

Sian ahhhh.

When can i go home?!
Can't wait for all this to be over.

weird stuff.

i realised that when i get stressed with studying, i turn to rather alternative methods of therapy.

1. getting super duper obsessed with cleaning.

check this out!

i dunno what draws me to this stupid duster but I
1. really wanna get it! comes in 3 sizes and all that jazz.
2. really like that creepy green colour
3. really wanna touch its seemingly 'soft' and 'whirly' bits..

gawd. help me please.

2. baking stuff that i normally wouldn't even eat.
made a whole pan of cheesecake brownies, which if you think about it, it's just a personification of the fact that I couldn't even decide whether i wanted to bake cheesecake or brownie.. so just do both!...

thankfully the encouraging bf took a piece and ate it all up really quickly. and..

he went "oh yummy, this is really really good!.."...
me: "oh really? i can feed it to others?"
he, 5 secs later. "oh by the way, what do you call this thing you baked?"

-.-"

3. super Yoville addict.
It's this stupid game on facebook that you have to work at the factory (!!) only once every 6 hours to earn some sad amount of coins. which i blow it all on furniture every day. to decorate my APARTMENT. oh, should i choose the red shaggy rug or the blue one?..
sigh.


HOW?!...
O&G sucks.
driving me mad! help!

bugger.

5 more weeks of O&G left! not sure to cry or rejoice. I'm only starting to get the hang of things in this obscure and diverse field of medicine/surgery. Just had a full day of tutorials that included running to and fro 3 different venues. My feet hurts from all that power walking man. Plus I'm still a bit queasy from the rapid ingestion of my pasta lunch. *ugh*

Anyhow, Paeds results are out! and I'm so relieved and also surprised by the actual percentages when Juanita (the nice clinical officer at WCH) replied my email. I crossing my fingers that I haven't tripled her workload because I just told a whole group of people that she would tell you the percentages if you bothered to email her. opppsie.

It's probably going to be a quiet friday night. Hopefully we will make it to the movies because I'm dying to watch wall-E!! I'm also gonna make dishes and rice for dinner. What I have up my sleeves.....

1. Ginger, Mirin and Soy Sauce Salmon
2. Sausage omelette
3. Choy Sum and Tofu Stir Fry

Yea I know, sounds boring right.

What to dooooooo.

Ok time for a bit of a granny snooze. Hur.

the long and short about labour.

having been rostered onto 2 long days worth of labour ward duties and a morning of c-sections, labour is seriously under-estimated. All the movies and drama series portray labour as something that is relatively short and always commencing with the exxagerated POPPING of the waters. On screen, the baby always comes out perfect and clean and the mother looking so neat and happy.

Well folks, in real life, you get a blue baby with a crunched up face covered in white slime. Midwives have to clean your baby before they look presentable to you. You would have had on average 5 hours of painful and regular contractions prior to the baby even being out of you. This is usually associated with a change of mood, hair getting dishevelled and lots of swearing and screaming before the pain medications are administered.

All you people opting to have caesarean sections for convenience, fear of a long and painful labour process or simply the fashion of the time.. are also WRONG. You always get a big scar, you have more blood loss, recovery takes longer. It's a safe and life-saving alternative but people should stop saying they WANT caesars.

At least it doesn't (thankfully) take away any of the joy and tears that comes rolling down your faces when you see your baby for the first time.

I guess what I'm trying to say is that labour is just the beginning of a long road of parenting. It's not pretty and it's not glamourous. You have to do it only because you want to.

Yes.... and i will save the rant about midwives for another day.

long time no blog

busy with the new rotation.. keeping me on my toes.

anyhow, time is running out! sitting for the BIG exams very soon!

RANT OF THE WEEEK::::


and i'm so pissed. with person that
1. eats bread and leaves crumbs (that amount to a piece of bread) on the table
2. cuts fruits on the kitchen top without a chopping board/uses plates as chopping board. (mankind invented chopping boards FOR a reason)
3. moves stuff around the house without asking for permission. (not your stuff, don't touch!!)
4. thinks that others want to use their things and hence keep it in their room! (am i the only one who thinks keeping kitchen utensils and garlic is just so damn weird?)
5. doesn' recognise/realise that the house is SOOO much cleaner and is blatantly contributing to dirt. (stop shedding hair/skin/dirt/wat have you)


why why why why why!!!!
ain't the above just you know.. COMMON SENSE??? and basic courtesy????

some people just never learn. or realise.



PS: DISCLAIMER: not my household. me housemates are perfect :)

why do we need true friends?

1. spend time drinking alcohol and laughing your heads off at sexual and explicit jokes.
2. so that we can sing unpretentiously in our loud and tone-deaf voices.
3. someone to turn to when the world is upside down, inside out and all the wrong ways around.
4. the ability to reminiscent about the common past together.
5. alibi for all the times you need to hang out late and be sneaky with XXX.
6. feel slightly wanted? nothing beats logging onto msn and having people scattered in different continents saying hi to you. hur
7. people actually looking to you for advice - relationship problems, online shopping - what to buy what to choose?
8. being appreciated for who you really are, and not what you want to be. less the need for impression.

i can't think of any more at the moment.

babies are eating my brains out.
and their very pregnant mothers too.

gahhhhs

the wheel of time just keeps turning and turning.

my well rested, full of afternoon naps weekend is OVER.
all i can say is, i'm glad i took time off to do abit of silly things.

like how we spent friday evening shopping! and me buying a few new tops from country road. i love that place man. we went off to belgian beer garden for dinner - lots of mussels! and pomme frites (which are just fancy potato chips) and accompanied by delicious stella beers! oh, the examiner from the paediatric osce was sitting at the next table. so paiseh. >.< lucky he was happily drinking his beer too. hah!

this was followed by 10 hours of sleep. and 3 hours nap. and FINALLY dragging my ass down to play baddy. oh sometimes i forget how much fun i get playing that game. it was really good, had some pro shots and broke a sweat. yay :)

and.. we had some shitass spicy nasi bryani from Rana's Tandoori! Which we washed down with a bottle of Corona each, so satisfying to eat spicy stuff in winter :)

Sunday, we continued our quest for food. We rode all the way to Hahndorf, a quaint little place in the hills 20 minutes from the city. Immediately dashed to the infamous POT BELLY PIES SHOP (which christine, quinnie and a few of our friends were unlucky enough not to have tasted coz it sold out the day they were there) We shared a steak and mushroom pie at the shop - saucy, savoury and alot of meaty chunks! I approve, even though I'm not a fan of pies. We bought 6 pies to take away and distribute to me household :)

Anyhow, my weekend is long over. It's nearly the end of Tuesday now, and I am still trying to grasp the idea of O&G. It's difficult especially if you did Paediatrics first. Abit topsy-turvy now. Oh wells, at least they are really nice about teaching and I have learnt heaps in the span of just 2 days.

Looking forward to more :) 9 weeks of babies and women! come on!!!...

people like to play tricks.

LOOK WHAT I FOUND IN MY STATIONERY KIT!
A 6 YRS OLD NEOPRINT!
ALL OF US LOOKING WEIRD AND ANGRY
AND HONG GETTING COVERED BY A HUGEASS FLOWER. HUR.

---------------------------------------------------------------

just had a taste of the surgical osce exam.
which went quite well, except for the QUINSY.

oh man, ENT surgeons sure like to kid.

anyhow, have to mug for med! and psych! woo hoo!

looking forward to the weekend!
sleeping in
shopping
eating indian takeaways with friends!
going to the hills to find a pie shop
playing baddy

WOO HOO.
come on come on!


now im worried.
what will i do post-BARRIER exam?

try bungee jumping?
o.0

winter's still here!!!

Alrighty.

Observed Case was alright. I passed!.. see, such low standards. hah. seriously, crawling and walking 14 mths old babies shouldn't be allowed to be exam specimens. they run around and you have to catch them, pacify them, make them breath so you can listen to their chest.

too much work man!

Got my assessment form signed off today.

"A Keen Student." -- eh, consultant... you sure not? Yah I guess was at times, but mostly I was just trying to NOT look disinterested. Murmurs get boring after listening to 20 similar "long systolic murmur, loudest at Left sternal edge.."

I saw a couple of malnourished babies in heart failure. and they look so tiny, starving almost. you can see the outline of their enlarged liver when they breathe in and out deeply. it's quite heart-wrenching. (pun NOT intended k) And they are in respiratory distress.. and it seems so hard for them to catch their breath.. poor lil things.

Anyhow, I was in the nursery today with the doc for some consults. He was telling me how I should visit the nursery often, "just to get an idea of what NOT to name your future kids." Seriously, the list of weird names is very long.

Some examples (sorry if that's your name or what you wanna call your kid..but i'm pretty traditional when it comes to names)

1. Jamain (variation of germaine? Not toooo bad)
2. Kyetrel (nurse commented mum mixed 3 names up to form this unique name)
3. Jaeda (likened to a jeidi?)
4. Qathy (HOW DO YOU PRONOUNCE IT?!)
5. Leilani
6. Fade (?????????)

I'm not sure... but am I the only one who think these names are weird?!

Sigh. What a world we live in.

week 4 blues..

I'm not sure why but I'm feeling really down and unmotivated. Maybe it is a combination of bad dreary winter chills, boring rotation and just plain boredom. It is really difficult to come home everyday after a long (maybe boring or useless) day and do your eating and showering things and just sit down and study. Things just get so pointless sometimes.

When will this all end?

Is there ever a light at the end of this long dark tunnel?

It seems like just as when I am about to finish crossing one hurdle, another one is on its way into my life. I keep stalling and going "wait until XXXX is done and then i can XXXXX".. Maybe I should just care less and do what I want to do RIGHT now. Stop thinking that my life is just mainly about studies and med and passing 5th year exams.

Afterall, my life is proving to be an endless road of sitting for exams, getting drilled by someone more senior and always always having to think of others before myself.

Thinking about all this crap is making me sad.

I shall go and continue revising paediatric ophthalmology (which SUCKS SUCKS SUCKS!!!!) I hate eyes. Only very grateful that I can see. that's about it.

Sidetracking now, people get abit appalled and disturbed whenever I say in a very affirmative voice that "I CANNOT STAND PAEDIATRICS." Are people meant to like kids? Are we meant to think paeds is a nice field? Oh gawd. And I hate people who go goo-goo and gaa-gaa at patients during a sort of serious clinical examination in front of a consultant. Goodness me, just GET ON with the exam. You only have 7 minutes to do it and you just spent 30seconds stroking the little baby's little hands. And he/she (hard to tell gender at young age sorry folks) is probably going to scratch the hell out of you because he/she has claws. LONG untrimmed fingernails are the future ammunition in our fight against terrorism. It has been around for age, proven safe, proven very lethal.

Hence, I keep my distance from babies. They are so unpredictable! They smell funny and they can't tell you how they feel. Argh. and they breathe so fast and their heartbeats like it's running on estacy.

Retrospectively, I think I have come to realise why I thought PICU was so great. It was the ICU part of things, not the P part of things. ahhhhhhhhhh.

what a life females have.

It's funny how male doctors are so sought after by the female species..The girls think they are intellectual, rich, funny, professional, caring.. etc etc etc.

Whereas female doctors are thought to be competitive, arrogant and too good and too smart.

Seriously guys.

Les Miserables - Come to Me

[Fantine is lying in a hospital bed, deliriously dreaming of her daughter Cosette]

[FANTINE]
Cosette, it's turned so cold
Cosette, it's past your bedtime
You've played the day away
And soon it will be night.

Come to me, Cosette, the light is fading
Don't you see the evening star appearing?
Come to me, and rest against my shoulder
How fast the minutes fly away and every minute colder.

Hurry near, another day is dying
Don't you hear, the winter wind is crying?
There's a darkness which comes without a warning
But I will sing you lullabies and wake you in the morning.

[Valjean enters]

[VALJEAN]
Oh, Fantine, our time is running out
But Fantine, I swear this on my life

[FANTINE]
Look, M'sieur, where all the children play

[VALJEAN]
Be at peace, be at peace evermore.

[FANTINE]
My Cosette...

[VALJEAN]
Shall live in my protection

[FANTINE]
Take her now

[VALJEAN]
Your child will want for nothing

[FANTINE]
Good M'sieur, you come from God in Heaven.

[VALJEAN]
And none shall ever harm Cosette
As long as I am living.

[FANTINE]
Take my hand. The night grows ever colder.

[VALJEAN]
Then I will keep you warm.

[FANTINE]
Take my child. I give her to your keeping.

[VALJEAN]
Take shelter from the storm

[FANTINE]
For God's sake, please stay till I am sleeping
And tell Cosette I love her
And I'll see her when I wake...

what a crappy week.

1. withdrawal and tiredness from a jammed pack 2 day trip to sydney
2. falling sick with sore throat and.. everything else.
3. paed surgery coming to a hault. doesn't seem to be learning anything new.
4. crappy rainy weather
5. realising studying sucks.
6. realising one is lacking in so much knowledge!

eurgh.

oh. but there was one good thing.
i saw the gp on monday.. and it was not cold sores! it was dermatitis..
so i applied some topical steroid cream for a couple of days.. and voila it's all GONE.

the miracle of steroids.
yippeeee.

i'm really looking forward to london.
but i need to PASS the freaking year before i have wild ideas running through my head.

considering watching les miserables?
the sounds from the musical is relli good.

alrighty world
time for rest.

因为....休息是为了走更长远的路。