***Note: This entry was written when I was still in the ward, in between patients. HAHA***
Hi ya... Updates from the ward... Its getting very very very very boring down here. Not much patients.. yeah- i know I should not be complaining.. but its finally getting to me... Morning ward round this morning finished in AFTERNOON.. (around 1.30pm-- dear God!) My consultant is nothing but THOROUGH. VERY THOROUGH. She's good though.
Quote of the day (so far): "My son is a bit of wimp" -a mum on her 4y-o boy who was afraid to be cannulated.
Shocking goss: i) A 2 weeks old boy came in with D+V (we have tonnes of them this afternoon!). His mum is 14yo. Yup, you heard me right. FOURTEEN! She's a child herself and now has this responsibility of looking after her own son. The best (or should I say the worst) thing is: She didn't know that she was pregnant until she was about 37 weeks. SHOCKING!!! ii) A 10yo girl self-harm, multiple cuts on both forearms. Hx of attempted suicide twice previously. Come on, seriously, whats happening with the kids these days. iii) A 9yo girl left hemiplegia with consistent MRI picture of right infarct. Bloody hell.
Hello all... I am back from Amsterdam, safe and sound. Right at this very moment, I'm eating Dutch waffles. Super sweet. Ah... memories of eating hot waffles (and pancakes!) along Amsterdam's cold, snowy canals.
Me and my traveling partner did all the usual tourists things (like going to museums, sightseeing, shopping and eating) which seem a bit too dull in the first place considering we were raging with energy to do stuff (30km of cycling for instance!). However, I have to say that this trip was satisfying (read: not truly electrifying) getaway as we had no break since we started second semester of 4th year of medical school.
Few museums were visited, plenty of paintings commented on. (Editor's Note: p53 usually wont give a shiiite about art, but boy, impressively she stayed and more importantly enjoyed herself for >2 hours at each museum the she visited!) Canals seen and streets trodden. Cheese tasted and bought for people back home. Learned that the Dutch word for snow is 'sneuww' and good lord it snowed like hell when we were there. Apparently the worst snow since the last 40 years. Awed for a lot of flowers (and i really mean A LOT- more than enough to make my mom go crazy). And of course pictures taken. Abundant!
List of MAGNIFICENT paintings (by p53):- i) Night Watch by Rembrandt (like wow! Infact I think I said WOW rather NOT softly, few visitors turned their head to look at me with a knowingly smile. Approving the awe to the painting not the loud WOW!) ii) Blossoming Almond Tree by Van Gogh (I love this one big time, I seriously think and believe that this is a greater painting than the classic "sunflowers") iii) Ophelia by John Everett Millias (frigging haunting in a very impressive way)
Flowers seen:-
Ok, enough of this flower business. Now the pictures around the city. (Last picture featuring a 3storey parking space for godknowshowmanybicycles!)
Everyone rides a bike here. Dutch or not (read: tourists). Men women kids old ladies old men. In flat shoes, in high heel, in leather boots, in Uggs boots! With/without hat, with raincoat, with winter coats. Wearing trousers, wearing sunglasses, wearing short summer dress, wearing school uniform, wearing mini skirts! I'm just simply amused. This is one very cool city! (How environmental friendly it is, not to mention that plastic bags are not in use here).
All in all, I really enjoyed my trip there. Different culture in different setting. Tulips are blossoming- so beautiful. Tall guys- also an attraction- of course I'm referring to those good looking +tall). The best selection of evening TV shows (all the latest season of US TV series like HOUSE, Desperate Housewives, CSI and many more). The best snow (read: heaviest) I had ever experienced. Yours truly.
Ah yes- I skipped the Red Light District altogether. Guys paying for sex, prostitution, women selling themselves cheap, drinking like there's no tomorrow, things people do when they are drunk: JUST NOT MY SCENE! puhlease. And I didnt try weed/cannabis/white powder/whatever name you wanna call it: I want to have control of my own mind. Why surrender everything to a hallucinogenic agent like weed.
PS: The hotel we stayed was a bit poo-poo. Do not stay at HEM Hotel Amsterdam. Way too out of the city, for backpackers alike.
PS2: How cruel can medical school be? One week holiday for Easter holiday with OSCE in next fortnight! On top of that I'm on-call this coming weekend (hell- yeah- you heard it right)- smack bang in my easter break. I'm so crossed its untrue!!!
Last night I read an O&G book in a frail attempt to revise for coming Osce. (I fell asleep after 1hr- booo!- nevermind that) and it made me realized how much I miss O&G. Everything clicks! So easy to understand all those bleeding problems, pregnancy related problems, etc. Oh- how I miss talking to women pre-operatively. Weird I know. I am looking forward to take the O&G Osce.
There are so much things that going through my mind right now. I'm just gonna type it out in the order that thoughts train checking in at my conscious mind station.
Favourite song at the mo
So fecking love this song. Must have listen and song to it (hehe, to the repeated complaints of housemates) like a million times since last weekend. It has got the carefree feeling to it. Feel good song as a summer theme (god knows when summer gonna comes- i mean- we all know when summer gonna be here, but considering the weather right now- i am fovever hopeless). The official video clip had recently been released despite the actual debut of the song was last year (Spring 07) and gosh it is damn brilliant. Jason Mraz has slightly changed from his "you and I both" days. Still cute though. It was filmed in Africa (well at least- looks like it was filmed there). Happy days!
Talking of which- I'm certainly going to Africa!Yeehaa.. I dont think I have mention it anywhere in this blog that I'm going to Africa for my elective. Yeay- repeat- I AM GOING TO AFRICA! Few other friends and me are going to Tanzania to one of the hospitals there. The hospital itself boasts good reputation for elective placements. Initially there was a debate between the four of us about which hospital that we all should go to in Tanzania. The verdict was divided between two contenders. I managed to put my case up front and really put my feet down about my preferred choice. And to my delight, the others finally agreed to go with my choice after rationalizing the pros and cons. I like to think that I'm influential enough to get others to jsut succumb to my suggestion.
Well, at least thats what I think. Hehe (pardon me for being like this!)
We surely gonna do a lot of activities there. Of course on top of our elective responsibilities (like going to hospital, health education to locals, community projects). The most important activity (probably in the whole wide world for me at the moment of time) is climbing Kilimanjaro. Then probably safari trip and beach trips. Well- list of the activities will be finalized soon. Watch the space.
KILIMANJARO. Anyone has any idea how much it gonna cost to climb the Kilimanjaro with an experience guide? I heard: GBP700. Freaking hell! That's way too expensive for me. Will I be ever to afford it (bear in mind- I have to save up to 1000quids for flight tickets, accommodation and living expenses). Must figure out something to get extra money. (Nayh- Im too lazy to have a part time job.... should I get myself a sugar daddy who is more than willing to sponsor my trip there?)
Not only there. I'm going to Borneo as well. Heheh. We are actually doing a split elective. Might as well cramp in as much as we could in the two months time in 2009. Hah! Borneo is natural heaven- or the closest to earth can get to in term of picturing a paradise. Again: climbing is the main highlight here. Yeehaa. Then maybe diving. Scuba diving for the professional PADI certified diving lesson. And again that gonna cost me a massive lot. (Editor's Note: You probably need sugar daddy and a toy boy to be able to afford all this electives business!)
Financially- I'm ok. Living a student life rather comfortably. Managed to chip in holidays (I will talk about this later) every now and then, going on random (I'm saying this with a bit of guilt hint in my voice-as I am saying it in my mind) shopping trips, and eating out ever so frequently. hehe. Latest buy: 2 ZARA JACKETS (went to the ZARA store and couldnt decide between two gorgeous jackets- so I took both! The retail devil in me!). Dont ask how much they did cost me. Rather worth the money for the classic trench as I received a lot of compliments when I wore it the whole 5 days last weekdays. Ha! Gleaming with pride I am.
Traveling wise: I am going to Amsterdam in two days time. Honestly this holiday was booked out of desperation last January. I didnt go anywhere during winter break. Seriously, NOWHERE- was stuck in SmallCity the whole two weeks of the break. So, I thought I should, I must go somewhere during the easter. However prices of flights and hotels are rather expensive even if I buy it that advance. (Imagine me wailing to the ridiculous price for holidays in warmer location- like egypt or marrakech- absolutely frustrated!) So I went on Expedia and booked the first thing that I saw on offer. Haih. Hope this gonna turn out for the better. I'm going with HM#4 (Housemate Number 4) and earlier on today we spent a couple of hours planning the things that we gonna do (read: cramming in every possibly things) in the four days we gonna be there.
Then, I booked another holiday to Morocco (this time with HM#4 and HM#1!). That's gonna be in JUNE. And this coming summer I'm gonna travel Europe -backpacking style. Woohoo- cant wait. (I told my parents I'm not gonna go back to my home country in exchange for the backpacking trip; flight tickets are frigging expensive during the peak summer season, might as well use that money for Interrail and youth hostels and see the entire Europe!) You guys must be thinking that I'm one of those spoilt brats with the lifestyle I'm currently living. No I am truly not. I just have poor control for my money. Life is too short anyway to stop myself from doing things I truly enjoy i.e. traveling.
Note to myself: Need to sort out visa for Morocco- bugger!!!
My studies is going down hill. My mom and daddy asked me this afternoon when I called them. "It's OK" I said without further elaborating the statement. I keep on sleeping. (also part of the reason why I havent update this blog in a while. Sorry guys!) Forgetting to do my PBL work. I look almost completely clueless during teaching session, blinking over simple facts dished out by my fellow colleagues. I need to read more but I just can find the will to do so. Its either sleeping or wasting time on the internet (Do you guys wanna know what website I spent my time most? Addicted to the whole perezhilton.com shite! And lately fashion blogs. I seriously dont know what has gotten me. What ever it is, it sucks!)
I have to put a bit more effort in doing my work and revising for coming OSCE: Oh no- that is less than a month from now. Crikey!
I cannot help but compare myself with two other students of my consultant. (3 of us are students attached to the best Paediatrician in my hospital). They are fecking hardworking (I really mean this- eg- reading till 3 in the morning) If that fact cant motivate me to work I dont know what could. Life isnt that tough, I only have myself to blame for this hiatus of knowledge in my own brain. These two students are the loveliest people that I have ever work with and they are so gonna make good doctors. Even when they have opinion on everything they are so well informed about every singe fact that they argue on or talk about. No point guessing which student the consultant prefers more.
There were actually a lot of important things that had happened in the last week. MEDSIN Global Health (interesting!), visit to special needs school (truly heart-rending!!!), fabulous GUM (STIs and AIDS) lecture (frigging funny!) and bouts of malaise that surround the household (?bugs?). Will tell a lot more if I have the mood to. Otherwise, I'm gonna pen off now.
I haven't been doing Paeds long enough to be an expert on writing this kind of stuff, but suffice nevertheless for my standard; as far as I'm concerned. You know how in daily routine of a doctor who works in Child's Health Department, he/she has to interact and deal with people from all walks of life. A bit like in General Practice and A&E I supposed.
The mix varies tremendously; ranging from neonates (clearly cannot speak) to infant (incomprehensible babbling) to toddler (mismatch sentences) to young child (very curious lot) to adolescence (unique behaviour --> can't really generalized them) to of course lovely (not!) parents. And then we have parents of different educational background, social class and dynamic with their child. Then there are kiddies who are unlucky enough to have speech delay for any reason.
Some doctors really do portray an image of a good communicator with the children. Really pitching it down to the kiddies level. In a rather cute and super friendly way, not putting up a humiliating act. For example: "touch your nose, touch my nose" -directing a child in a sing-song voice while testing for cerebellar function. Some just can't be asked: which make me wonder why bother being a Paediatrician if you genuinely hate kids?
Addressing a child as a Fraser's competent being (talking/asking the child to explain rather than going straight to parent) is a good way of building up rapport with the child. Ok, possible not the non talking kiddies. That's fair enough. But for toddler who can understand what we mean, I would definitely advised approaching the child first as an autonomous being. Plus, it is much fun hearing a child trying to explain him/herself. "I had pain here... my mom gave me calpol. She said I have temperature. I dont think I have temperature".
It will make a big different I think if a child is treated as an autonomous person. A doctor can try to include the patient in the management. For example: "Do you think you can go to the loo 7 times a day?" Patient will feel that the doctor has put some degree of trust in her/him. "Yeah, I'll try, I'll let you know how it goes....next time I see you" (real case of management of daytime wetting in an 8-y-o girl).
Then while doing the physical examination, please don't medicalized the test. Alter it into a child-friendly step. I think the best way is to demonstrate it on ourself. Like this: I want you to blow into this paper like this (then proceed to show how). With the tendon hammer or the stestoscope, let the child touch it first. (real case of a child who cried upon seeing the tendon hammer as she was afraid that it gonna hurt her). Let them know that its not gonna hurt. Seriously. Sometimes we as an adult forgets.
Adolescence. Hmm... been there, so I perfectly understand what exactly they are going through. Of course every other doctors had gone through the same phase of life. So we all should know how difficult it is to be a normal teenager, let alone teenager with (embarrassing/chronic) medical condition. "My friends think I'm a freak show as I inject myself (with insulin) at school" (again real case). Personally I like to share a personal story/ experience when talking to teens. "I remember times when I was called a freak too. Just because I wore braces at that time". Its all about making the teenage patient comfortable in speaking to you.
Its a tough call I know and I wont stop improving myself. Promise.
Today a patient opened up to me and another medical student about her past history. She was raped (!!!!!!! I couldnt believe what I was hearing at that time; utterly shocked) 3 yr ago and the her Paediatrician doesnt even know about that (Presenting complaint: a year hx of unspecific abdominal pain, missing school and learning difficulties). Talk about shocking news!!! I guess she must have found it easier to tell us about her problem.
Dr P Aed was glad that her afternoon clinic had finished. She has long clinic list, possibly the longest of all (paediatricians in her hospital). Oh well, for the apparent 2 reasons I guess: i) her intense dedication for kiddies and ii) her being so nice to not say 'NO' to extra appointment.
She looked around her consultation room- toys scattered all over the floor and a messy table: used cups and a dictaphone [she has to dictate a couple more]. 'Later' she said as she headed to the clinic's WC.
As she entered the toilet cubicle she noticed lumps of stool bobbing in the toilet bowl. Gross, I know. Lightly colored, yellowish she said. Offensive smell. Yikes! Whoever used the toilet before her certainly need to learn his/her manner. Flushing isn't that difficult. This must be a case of an irresponsible being.
Gosh, what should she do now? She was completely innocent though, being in the wrong place at the wrong time. People will certainly think that she was the one who made up the mess. The next person will assume that as if its hers. No, surely that cant be right, 'I'm a respectable consultant' she said 'and I dont people to think otherwise'.
Flush- flush- flush!
NOOOOOO! She wailed quietly. The stool was still floating. She felt queasy, prick of sweat started to appear on her forehead. The more she focus on the stool, the more she felt as if the stool was looking at her, mocking! Dear God- what should she do now?
Let give it another couple of tries. Flush... not flushing! She almost given up hope then. FLUSHed for the last time.
[Camera panned from her view to about 10cm away to the toilet bowl] WHOOSH.... gurb..gurb..gurb...[in a slow mo version] the stool thankfully flushed away.
Dr P Aed couldnt believe that this is ever gonna happen to her. Disgusted but relief, she left the WC back to her consultation room.
AHA... She just remembered that it was actually the day of a CF clinic too. Classic!
****end of story**** this is half true, half made-up story. i'll let you decide which one is which. INFOs: CF (Cystic Fibrosis) is a condition where there is a defect in the Na/Cl channels on the cell surface resulting in problem with digestion and respiration. The actual condition described in the story above is STETORRHOEA. Poor fat absorption in the intestine result in high fat content in stool, making it very difficult to flush and smell really awful [due to bacteria's action]. It is typical to have to flush it a LOT of time to clear it completely from the loo.
(Editor's Note trying to be the devil advocate, hehe: Imagine having to clean up the loos after a big, national level CF patients get-together! Let have a plumber on standby.)
?Acute Nephritis ?Angina ?(insert medical term here)
Often I come across the ? phrase in medical notes (electronically and on papers). The queries range from rather vague symptoms/explanation (?constipation) to the more worrying ones like ?PE or ?Placental Abruption.
As a junior, it is very tempting to query just about anything. The easiest trap is to ?(insert common condition) on the basis of association. For example: ?Eczema for a non-specific rash for a patient with history of hay fever or asthma. Yeah, its true that they can co-present in a patient but there are a lot of other differentials for rashes.
If we think that what ever it is we are querying if worth mentioning, then surely it is worth investigating. Do not ever leave it just there.
Let me explain this by giving a scenario.Say a 25y-o Caucasian man came to GP complaining of 3 months history of dry cough and weight loss. Patient mentioned about him working as a builder and does a lot of works outdoor- making him very tired at the end of the day and feeling unwell sometimes. No other complaint otherwise. Generally fit and well.
As the coughing was more of a nuisance for him (I'll be fine with some cough syrup- he said), I prescribed him a cough linctus. ?TB. I was certain he would be fine.
Few months afterwards he was admitted to hospital with haemoptysis. X-ray showed cannonball lesions in both lungs and massive multiple mediastinal lymphadenopathy. AFB test was positive and he was treated promptly with the TB regimen (4 meds).
Looking back at his medical notes, "?TB" flagged up. Everyone questioned why didn't I investigate that further then? Considering that it had already crossed my mind.
This unfortunate guy could have died! He certainly not gonna be happy about his doctor knowing that there was a possibility of TB (?TB) but not taking it any further.
You get what I meant now? If its worth mentioning then its worth investigating. Anyone who is caught up in situation like that will have to put his feet in his mouth. No way out!
Remember: i) Do not use ?X just for anything. There are implications ii) Refer to your senior if in doubt. "?TB, spoken to Resp Consultant- he agreed to have this patient under his list- non urgent referral" iii) Beware of patient's anxiety "?Diabetes- Patient: Do I have to inject insulin now/soon etc"
Fuh.. I managed to get through my first week in Paeds without missing anything. So far so good. Have not yet pinch any kids. Hahah, Not that I wish to do so ever so frequently. Reserve for naughty kids. A pinch can hardly do any harm, unless of course he/she has blood problem like haemophilia and the likes.
Few times when I woke up in the morning, I felt as if I dont want to leave the comfort of my duvet (or in fact my friend's duvet). Slept over at her place twice this week alone, as me, her and 2 other friends were busy preparing a booklet for a conference organized by medical students here in my base hospital.
Surrounded by perfectionists and being one myself, everything regarding the booklet will be cross-checked 4 times. Every minute details will be scrutinized. Front cover alone took us hours. (Editor's Note: The fact that p53 doesnt have a clue on how to use Adobe Photoshop made thing worse. She went ballistic when the Adobe kept on asking "Do you want to rasterize the layer?" --> Wtf is RASTERIZE- she asked.)
Conditions seen (and have to revise about): Absence seizure, cerebral palsy, Asperger's syndrome, pilomatrixoma(!), aggressive behaviour following cakes ingestion(again !), the usual cough and colds in GP, Measles, Glandular Fever, ADHD, recurrent UTI, piles (errkk) and of course CONSTIPATION.
Never underestimate the proportion of kiddies experiencing constipation (almost a third of all OPD consultations). Poor diet consisting mainly junk food is the culprit. Lack of fluid too. Not liking vegetables' not helping. Some parents themselves dont normally have vege in their diet. I read somewhere that with prolonged constipation, the child will learn to avoid defecating (through conditioning) which only gonna make matter worse in long run.
Lactulose and Movicol. Remember. Increase dose, manage in primary care.
My Paeds consultant advised a 10y-o girl to exercise more and eat healthy diet. Walk to school, go swimming, eat more green and fruit, cut on sugary drink, and stop having snack after 8pm. The girl just nodded. She probably forget half of the things mentioned. Even if she remember them, the advices will be quite tricky to follow.
ME 1: What is happening in this world? Dietary advises and diet diary for a 10-y-o? ME 2: Better to have all the advices now when she's much younger. ME 1: But still, she only young. She should enjoy food. ME 2: She'll thank the doctor later when she's a teenager, Hmm, a NOT FAT teen. ME 1: Is the girl is to be blamed then if she is super dieting (to an anorexic level) then? ME 2: Fine line there mate!
There are a lot more. Cant be bothered to type them out. Haha. I need to catch on sleep. Lack of sleep for the last few days had given me black eyes (not the iris, duh... black patch underneath the eyes). Not pretty. Eating pattern had also become ridiculous. Hope all will get better once I go further into this module.
PS: I slept for a complete 13 hours (Friday-Saturday) PPS: American's Next Top Model Cycle 10 is now out! yeay.
As far as i can remember, I have always like to sleep. However I don't know whether this is innate or environmentally influenced. The pretty part is thankfully genetic!
