Yippadeduh, yippededuh....

I'm leaving for my electives today. In less than an hour.

Here are the dates roughly...
Today- leave smallcity
Tomorrow- arrival at Tanzania
Next weekend- trip to Zanzibar
Next next weekend- safari trip (Serengeti +/- Ngongororo)
The weekend after- shopping in Dar Es Salam
4 weeks from now- leave Tanzania for Borneo.
4 weeks +1 - will be in KL
4 weeks +2 - arrival at Sabah
The first weekend- beach and snorkelling
The second weekend- climb Kinabalu
The third weekend- white water rafting +/- visiting orangutans
The fourth weekend- flight back to the UK.
Fin.

Yeah! I'll be globetrotting with just the basic necessities. No laptop- so expect scarce entries from here on. All possible methods of transportation will be used so maybe this trip is like a little "By any means" imitation. Haha.

Till then, love you all.
p53 xoxo

PS: Those who want postcards please leave address as comment. Its my pleasure to sent them.

Pain and shit

"The word 'depressed' is used so much these days. "I got stuck in traffic, I'm so depressed." "I'm having a football depression." If only you know what it really mean!" ~Patient who recovered from a brain injury~

"When you learn to die, you learn to live" ~ A patient~

"Depression is trendy, if you dont have it, then there's something wrong with you" ~Another patient~

"Bathroom is full of risk factors" ~ Geriatric patient

"Blackpool is pretty... (long pause) shitty." ~patient who types out his words- dysphasic after brain injury i.e. someone smashed his head.

Malicious

"What are the things that you should consider while listing a patient who is adiposely challenged?" ~Surgeon of the week~

"Antipsychotic meds will definitely make a patient put on weight" ~SHO in Psychiatry
"I have to try it!!!" ~Me - pretty determined.

"After all these years I still find it difficult to talk about my illness. Its like a psychological scar that haunts me" ~ A patient

What to wear?

Apologies for the lack of post.
I'm dead busy completing all the compulsory assessments at the hospital.

I'm getting ready for my electives.

Many aspects of the preparation (i.e. vaccinations, money, accom, flights, documents, books, equipments etc). Most daunting is PACKING!

Its difficult to pack, I'd love to bring items that are both practical and nice. However, TANZANIA is burning hot, even wearing jeans might give me some trouble. Hmmm.. I was advised by many people to bring only the thinnest clothing item ever (so linen works best).

I'd love to wear my lovely pairs of jeans (black and dark blue) which work just fine in hospital here in the UK- because both of them has this formal casual look. Definitaly I cant wear any of them for Tanzania is too hot! Now it seem that even my khakis -denim material- may be to thick for safari. Haih.

I'd love to wear different pairs of flats for different occasions. My cobalf blue flats will look so hawt (hot) with my capri jeans. And my usual black and white flats will so work with my hospital attire. And my red one just for days that I feel like wearing it. But no! I dont have any space in my backpack for an extra pair of shoes. So, black simple flat it is.

Scarves: I dont want to discuss about this... too painful.

Tops- Khakis, plain white tees, beige, olive- well the plain ol boring colours. No choice really.

Do you know that its a MUST to wear labcoat in hospitals in Tanzania AND Malaysia? Argggghhhh... another impractical item i) white- so will definitely will stain like hell ii) will only make life hotter (for bad reason, not for hawt reason).

And then I need all those travel related stuff (i.e. raincoat, sleeping bag, mosquito net, torchlights, first aid kid, travel medications, water purifier, thermos, hats, socks, gosh... many more.... arrgghhh). so heavy all this stuff.

And to make thing worse, I'm climbing Mount Kinabalu in Borneo which is pretty high >4000m. So I have to pack all those jackets, thick socks, gloves, thermals.... why oh why....(pulling my hairs out!)

I love travelling but I hates to have to choose what I can bring along and what I cant.

If only I'm rich enough to have some one to pack for me, arrange all my travel details, and as I'm that rich I'll travel first class hence no luggage allowance limitation and I can bring anythg and everythg I want, and that rich that I'll buy things (read: more nice shoes and clothes) as I go along to help the local businesses, and finally to have someone to porter my stuff around and be my driver at the location. Ahhhhh.... Plus a personal chef wont hurt.

Patient tales (except that none of these are fairytale)

When I woke up on Friday the 13th, I just wanted the day to come to its end. I was very tired from all the week doings with all those crap assessments, useless PBHell and running around to sort out thousands of stuffs. And you can tell from the way I'm writing that I hate them all.

So despite my endless cursing, I made my way to the surgical ward for a freaking 8am start and joined the Surgeon of The Week (SOTW) Grand Round. 1 consultant, 1 registrar, 1 SHO and 2 FY1s. The SOTW team reviewed almost 40 surgical patients in all wards (surgical, paeds & gynae patients).

I came across alot of unfortunate patients all of which left me so emotionally ridden.



Patient 1: 32 yo female patient who came in with small bowel obstruction. She had hx of a number of pelvic operations following diagnosis of and recurrence of cervical cancer. She has nasogastric tube in currently, as it was decided that her bowel should be rested.

I had a chance to speak to her afterwards. There were some parts of the encounter that I became very quiet as I was lost for words. It was very heart rending to hear someone of her age talk about three small children. For me it was the fact that all the problem started when she was 29 that did it. Thats like me in 5 years time.




Patient 2: 44 yo female patient who was diagnosed with pancreatic cancer post staging CT. She was told that operation will be arranged towards the end of this month. She asked the consultant whether she could have a weekend leave to see her newly born granddaughter. Unfortunately, she had to stay in-patient as she was markedly jaundiced.

Thats awful.




Patient 3: 23yo male patient who came in post vomiting and severe pain radiating to the back. Scan showed generalized moderate inflammation of pancreas. Dx: Acute pancreatitis caused by alcohol binging (while he was watching the Liverpool vs Manchester game nonetheless).

Consultant: Bla3x (re: long term effect of heavy alcohol consumption). You have to choose which one you love more. Alcohol or your life.
Patient: Errkkk....




Patient 4: A 39yo businessman who had been quite unwell (pain, n+v, although he was not jaundiced) for the last few days and investigations showed cancer of the head of the pancreas. Breaking bad news was particularly awful as it was done at the bed side with all 7 members of the SOTW team gawking. He was calm although there was hint of turmoil brooding underneath. The whole group became deafeningly quite when he asked:

"Whats the chance for this lesion to spontaneously heal itself?"
Consultant: Nil. Bla3x (re: prognosis, options, further ix inc staging CT and MDT)

"Can I have a weekend leave to sort out things?"
Consultant: Bla3x (re: potential complication of cancer i.e. bleeding 2ndry to liver problem, pain, jaundice...which might happen when he's away) So its highly recommended if you could just stay until after the staging CT.

"I need to sort out my business this afternoon (Friday). And just be with my family over the weekend. Gosh. Then I have to write a will."
Consultant: (Giving the space a sweeping glance). Well.... yeah, you can leave by lunch today after the girls check your INR but you have to be back by Tuesday at the latest.

It was eerily quiet. Of course, he is this young man who has alot of things to look forward to in his life at this very moment. Ooo... has I mention that he's an American? Who moved here few years ago after marrying a British woman and has established his own business based here in Lancashire.

I stood there at the edge of bed silently praying that he's alright with the news delivered and may he find strength and faith to cope with the diagnosis and its implication.




Those 4 patients were patients that made me shuddered. There were a lot more (ranging from simple appendicitis to ruptured ones, colorectal cancer, bile leak, retroperitoneal abscess, pilonidal abscess and etc) so much so that by the 12 pm I was crying inside. (yeah, a combination of many many many bad news and my own tiredness and worsening pangs of hunger).

Let us take few minute to reflect the value of life and to say prayers to these patients.

Later that day, I watched ComicRelief. For full 8 hours. 7pm on friday- 3am on saturday. The cause for this year is malaria in the Africa. So few more tears were shed after clips showing how kiddies in Africa died of this preventable disease, which is almost eradicated in other part of the world, due to lack of mosquito nets and medication to treat malaria victim.

Again, let us take few minute to reflect the value of life and to say prayers to these children. And say grace for having what we have.



Hugs and kisses with much emotions,
P53.

PS: As we were leaving patient 4's cubicle, he asked "Doctor, is theres any reason why I shouldnt use Viagra over the weekend?"

Blake Lively vs Kristin Stewart vs Leighton Meester

I found an old copy of VANITY FAIR while cleaning up my mag rack (yeah yeah, im still cleaning up)- so here you go- scanned and presented to all the readers of this blog.

On cover of Vanity Fair -from ages ago.

And this is the pic on the first page of the article.

I still hold my grudge against Kristin Stewart.
She's tad weird. Bad bad bad choice for Bella (of Twilight series).
Look at them pics, she's damn stiff, blinks too much, and too sulky!
Blake is so lively (haha, pun intented-well, its so sad that I keep myself amused with lame joke this) boo.
Ok, seriously, Blake is so pretty, full of live, fresh, young and happy.

K-stew is everythg but.

****************Spoiler alert****************

In book 4 Breaking Dawn, Bella turns into a vampire. And from the description, Bella would be so amazingly abso-fucking-lutely gorgeous! Hands on heart I dont think Kristin Stewart is in any way eligible for the character.

Yup, she's clumsy and all that, but I think Leighton Meester should be Bella. She is wayyyyyyy better at acting, plus she is this most lovely little lump of an actress with real emotions!

Eg: A very simple girl who fall for Edward (everybody says aaaaawwwwwwww... says woooootttt.... Shot gun Edward!)

Then: For New Moon. Bella curled up in feotal position cauze it just to painfulwhen Edward left her (everybody says arrrrrggggghhhh) - well maybe sans the heels and puffy skirt. haha.

Then: She turned into this most beautiful creature, even words could describe her. (Well, stephenie meyer described her well, I cant!) in book 4.

This is just out of world man!

OK!

Thats enough to prove that Leighton Meester is more suitable for Bella's character.




Its difficult to find a good picture of K-Stew.
This is the best.
And even that doesnt compare to Leighton's.

Bicester Village

Noted at the back of Bicester Village's shopping brochure.
(How to get there section!)

Bicester Village is a retail outlets area. So many PRETTY things. I was all excited. BFF drove us 3 hours there and another 3 hours back. Spent about 7 hours there and about the cost of a small car collectively.

Good day!

PS: I'm definitely not a bum when it comes to shopping.

Managing an arrest

I attended an ILS (Intermediate Life Support) course the other day. All of us 5th years are required to attend one before graduating. So hopefully everyone with be equipped with the necessary skill needed by the time one start working as FYs.

One of the ILS instructors looked familiar. He was one of these people that you come across alot in hospital (in wards/in canteen/along the corridor/in shuttle bus) but yet still don't know who he is or what is his job really. Of course me being me- I want to know everything about everybody. So when I first saw him that ILS morning, it was killing me that I don't know who he is.

By lunch time, we were split into smaller groups so that actual scenarios of cardiac arrest could be simulated for a smaller number of attenders. I was in his group. Then for the first time in 3 years I heard his voice. And you guys would be amazed to know that he speaks in a language that I don't know. Yup. Really.

So there he was yapping about stuff (stuff because I had no idea of wth he was talking about) to the whole group and me straining/struggling to understand what exactly he was going on about.

He speaks English.

English with heavy Welsh accent.

I swear to God, out of all people that I've heard giving instruction for the whole 5 years I'm here, his accent was something of a different level. Well above the level of thick Lancashire accent of an 80y-o gentleman, the Scouse, the Scottish, the newly arrived doctors from India/Africa, Manglish of the IMUs students and the rest.

So imagine the shock that I had when each of us had to manage a case of cardiac arrest each, having not understanding half of the guideline.

Well initial shock anyways.

Luckily I kinda well abreast with the ILS algorithm.

And its not a simple one I tell you.

Learning Points:
i) Double check the medications with at least another person before administrating them. Beware they all start with "A" (Adrenaline, Atropine and Amiodarone).
ii) Keep calm and carry on. (sure as hell one will be nervous with the adrenaline rush when put on spot managing cases like these).
iii) You can refuse to do mouth-to-mouth resuscitation provided that you have a strong reason not to and could justify it in the court.

Question:
Ok now I had my ILS cert already, when I can do the ADVANCED Life Support Course??

Plastic Surgery

Mrs X is a 40 y-o patient who I met in a surgical ward. She comes to hospital this time for an elective removal of bone spurs and local debridement on her left femur.

The story was: about 4 years ago she had a tiny wee spot of infection of the skin overlying her left patella (that's knee cap for you and me). Fast forward many Abx and few months later, the infection was still there- unshifted. By this time she was feeling unwell with signs of mild systemic infection- hence she was admitted to hospital for IV Abx. However- as she was feeling no better- an aspirate was done + a scan of her knee joint. The infection had spread to her joint cavity (now its about a year since first skin presentation).

So: Her left patella was removed and the joint was replaced with a spacer (p53: is it like an artificial joint, like that of a knee replacement? Mrs X: No, its just a space-filler, the knee could not bend as well. P53: ooo0000ooo *making mental note to check how does that look like/work?*)

1year post-op, she noticed pain while walking and reported "feeling a bit off". Symptomatic treatment was given and she was enlisted for care of Chronic pain team. Many neuralgic meds later, the pain persisted- now about 2 years post op. Second opinion was seeked and she was refered to Smallcity's base hospital.

After doing few more investigations, it turned out that she was having osteomyelitis then (which explain the pain and her feeling unwell). Due to the level of permanent damage of her tibia and fibula, they were removed too.

And for the first time in 3 years she felt completely well (how ironic is that being just under 40 and yet so calm/blase/accepting to the fact that she's an amputee ....... gosh, I thank God for my legs and my well being... go on say your prayers now!) and she resumed her work as an administration staff at school.

However, the happiness didnt last long (well.... I have to use one of those cliche havent I?). Roughly 6months after she felt unwell again. The osteomyelitis had spread up to her inferior end of her left femur. (So the infection had been so mild, so low grade, it had spread to a wider area unseen macroscopically right from the very beginning!!!)

She unfortunately had an above-knee-amputation. (She said and I quote: I would rather keep my life than keep my decaying parts).

Since then she had been in hospital 3-4 times for removal of spurs (even doctors dont know why they keep on coming back) and local debridement.

She is currently under the care of the Plastic Surgery team. She can walk with a prosthetic- although not mobilising at the moment due to recent surgery. Bless her. She has been through a lot and still pretty optimistic about her life.

PS: She's such a good historian!

This is the epitome of mother of all reasons why I dont want to do Plastics. Too gruesome, too heart rending, and too surgical. haha.

M*** ***

To all my lovely friends and families, crushes and lovers, enemies even, teachers and consultants, Jeremy Clarkson and Gordon Ramsay.

I MISS YOU all.

Every step I take, every move I make
Every single day, every time I pray
Ill be missing you.

My lil bro esp. Hey there, how you doin?