Today we ended at 12.30pm. I forgot how awesome that feels. 
Reviving old literature. Thanks Gareth, and dedicated to Ern.
PART 1 – In which the protagonist is introduced
Once upon a time there lived a young boy named Billy. Billy was five years old. He had blond hair, brown eyes and a cheery disposition.
Today was Billy’s first day of school. Because of this, Billy was very excited. “It’s my first day of school!” he said happily, as he skipped along the pavement holding his mother’s hand. “I’m so excited!”
Billy’s mother smiled down at her son. “Now, now, Billy,” she said, “calm down. We’re almost there.”
Billy continued to frolic in joy and delight. The brightness of his smile blinded a nearby mosquito, which fell to the ground in shock and was squashed by Billy’s foot. But Billy was too excited to notice.
“It’s my first day of school!” he repeated joyfully.
“Indeed it is,” Billy’s mother said proudly. She quickened her pace to match her son’s.
When they finally arrived at school, Billy rushed to his first class, leaving his mother waving wistfully behind. He sat down at the front of the classroom and waited.
And waited.
After five minutes the whole class had arrived. Most were sitting trembling at the back. “Come on up here, children!” said the teacher in a friendly voice. “I won’t bite, you know!”
So the children (apart from Billy, of course) moved cautiously to the front. Billy beamed at them. They stared uncertainly back.
“Today we’ll be doing a little bit of art,” said the teacher cheerfully. “I want you to use these crayons” – she pointed to some crayons – “to draw this apple.” She pointed to an apple. “Doesn’t that sound like fun?”
There was a pregnant pause. The children shuffled their feet.
“Yeah! That sounds great!” said Billy happily. He grabbed some crayons and started drawing. The other children stared.
A large bead of sweat formed on the teacher’s head. She had never encountered a class quite like this one. “Come on, children,” said the teacher in an encouraging tone. “Look at” – she checked her roster – “Billy here. See how fun it is for him?”
Billy beamed again. The other children nodded slowly.
The teacher sighed. It was going to be a long day.
To be continued…
Unbelievably, for the 2nd week in a row I managed to drag myself out of the house to run 10km. Keep this up and I might actually have some semblance of a healthy lifestyle going. I’m trying to be optimistic.
Psych posting is over and I’m grateful having gone through it. I still remember the first patient I tried to go “cold turkey” on in Gen Med posting… this elderly gentleman who thought he was a 20 year old fireman. I was petrified. This was before I found out you could check the TV screen at the nurses’ station to avoid all the “PSY” patients.
Then in Surg, there was ”a good case to clerk… but she has depression so better not talk to her.” We were afraid we’d make the depression worse, or whatever.
So I started Psych posting apprehensive, not knowing what to expect, since all the patients I had steadfastly been avoiding were now all going to be in the same ward. I admit I must have had a misconception that Psych patients were fragile, and somehow “weaker” than everyone else for breaking under the pressure. And so this minimized the idea of their suffering - made it harder to be sympathetic, to believe and want to help them.
But I was wrong. 4 weeks in Psych humbled me greatly. Each patient was different – each one had his own story to tell; I realized that it didn’t matter how they came to be where they were, that their illnesses were very real. I’d had no understanding of what it means to feel like life is empty and meaningless, like nothing interests you anymore, not being able to sleep or eat or function, always thinking of ending your life, or hearing voices telling you how worthless you are. A man with psychotic depression who saw a ghost every night, telling him to kill himself. A lady who thought her neighbours were out to get her. An alcoholic deeply depressed about his circumstances. Another lady, once a successful professional, now pacing the corridor and incurably anxious. A stick-thin girl who cried when a plate of food was put in front of her. A man with panic disorder and a dependent mother, fearing for his job and livelihood. A lady with OCD, whose family had been pulled in to ”help” in her checking behaviour. A chronic polysubstance abuser, on a secret and special mission. A man with schizophrenia who tried to strangle himself with raffia.
It was sobering. It was also very emotionally exhausting to talk to patients for 1-2 hours at a stretch. So although Psych is incredibly interesting, I don’t think I’m cut out for it. At least I can say that after 4 weeks of exposure, I’m not going to be avoiding any Psych patients now - I know how to handle the 20 year old firemen.
I also come out of Psych convinced that I have a lot of maladaptive personality traits. Paranoid, narcissistic, etc. So that was useful.
The previous week was a good week! Posting to IMH was eye-opening. After all the stories, it turned out to be better than I expected. The day before EOPT we got posted to the Child Guidance Clinic at HPB for an afternoon – very fun, the 2 ADHD kids we saw were very cute. Heh. Gen Med results came out, finally. And EOPT went well.
Alas, my 11 glorious weeks at SGH are now over.
The worst thing about having EOPT today was snapping awake at 6am with a funny feeling in my stomach. Not in the past few years, I think, have I woken up at 6am on Saturday. It’s even worse than med EOPT. This is on top of knowing that Patho CA is soon, and having to watch enviously as others skipped out of SGH, almost every day this past week, with their EOPTs over.
The stars were aligned. I had a nice young (English-speaking!) lady who gave me a straightforward history. My examiners were very friendly (and also very late), which allowed me to think through things properly. I had time to write down nearly everything I know about acute pancreatitis.
Someone should have mentioned that vascular cases are so popular in NUH. 3/8 in my CG. I will miss CG13, they are all great ppl, who laugh at my jokes. Sometimes.
There’s a lot of luck involved, running around the wards.
For example, lipomas are supposed to be fairly common. In 7 weeks of surgery, I have seen one – a 1cmx1cm lipoma on a patient’s foot. I tried to elicit a slip sign and that leetle lump just buried itself out of sight.
This is not for lack of trying. I’ve been going to clinics and scouting the pre-op lists when I can. The closest I came was when I went down to ASC to see this lady who was supposed to have a lipoma on her back. Talked to her for a bit, asked her for some NS advice since she works in CMPB. She said the lump was quite large and was bothering her a lot. I nodded sympathetically and told her that the surgeons here are excellent. Inside me, that depraved medical student was doing cartwheels because she has a big lipoma! Wow!
So I asked her if I could just examine the lump quickly before the op. Sure, she said, why not. I wandered off to get a chaperone, and when I came back… she was handing over her valuables and prepping for op. This is where you submit your story to the “FML” website and people vote and tell you “you totally deserved it.”
This other time, I was in HPB clinic. My reg was seeing a lot of follow-ups so I thought I’d pop over to the consultant’s clinic for a while. I waited outside and walked in after this pleasant-looking Indian gentleman walked out.
He had Dercum’s disease.
Argh.
So, luck. Or Murphy’s law or whatever.
But it’s ok. There are other things that make up for it. Last week during rounds, we passed by this guy who looked like he had a paraumbilical hernia.
Cool, I thought. Never seen a paraumbilical hernia before.
So we went back to look at him after that. Not only did he have a paraumbilical hernia, he also had hepatomegaly, a colostomy bag, bilateral ballotable kidneys, asterixis, and a grade III PSM.
After 7 weeks in surgery, it’s so good to hear a PSM again.
Today we spent the day in OT! It was a histopathology day. Followed a pelvic mass specimen sent for frozen section and got to see how the pathologists work – ended up being a ?dermoid cyst / teratoma. Then they let me cut open a resected colonic segment and GB. Really cool.
I think we’re incredibly lucky to be in SGH surgery.
“If the main purpose of your life is to study hard and be a good doctor, then studies are hard, but life is easy.
But if your life’s calling is to know God and make Him known, then life is hard, and studies are easy.”
- Ninja S, 3rd year medical student
I still wonder what would have happened if I’d done surgery first. Mostly because there’s this nagging feeling that I should have worked harder and learned more during gen med. I slept through that first posting.
Still, there would have been no coconut trees. And no life lessons or interpretations of the true import of death. That alone makes it worthwhile – and there’s always electives.
This past week in urology has been eye-opening. The first day we stayed back for exits, which comprised 2 patients. Yes, 2. Next week more than half the department is going on leave. I mean, in which other specialty are you able to function at less than 50% manpower?
Urology is awesome! They really spend a lot of time with each patient, in the ward or the clinic. The diagnosis is straightforward – stones, infection, or CA. And there are all these cool trans-urethral procedures they do.
Past 2 days especially have been great! Thursday turned out to be an accidental hernia day. Everyone else had decided to crowd up at the OT to watch a radical cystectomy, so I had the clinic to myself in the morning. Straddled 2 rooms and popped by to procedures every once in a while. I bumped into the incredible Dr HH at a cystoscopy, and it so happened the guy had an inguinal hernia as well, so I got an impromptu hernia tutorial. Then went to follow Dr T on call, and it just so happened that she was seeing an incarcerated hernia at A&E.
Yesterday a tutorial was pushed back so I went to the OT early. Watched the last part of a TURP, then hung around as the next patient went under. The anaesthetist was awesome, he let us pump the bag. It was terrifying in the best possible way. I have never felt so acutely before that someone’s life was in my hands.
There is our IHD therapeutic seminar to prep for, case write-ups to do, colorectal to study for next week, patho to mug, script to write, letters to draft… so many things and so little time.
My brother came back Saturday from playing in 74/08. A batchmate just posted some videos on facebook. 3 years, 12 batches later, the first thing that comes to mind is that feeling of weight on my shoulders as my hat started to spiral downwards. Haha.
Totally by accident, now I think I understand a bit better. Humbled and contrite again.
Surgery at SGH has been extraordinarily awesome so far. P & I did night call last night with our team. It was fun! Watched them clerk the new admissions; felt a few livers, a spleen, a thyroid; moseyed around A&E for a while trying to appear useful. Most memorable moment was talking to the poor young lady with a needle phobia.
Our tutor seems a little perturbed that we insist on sticking to her like leeches… but I think she’s resigning herself to it. Sometimes you have to be a bit thick-skinned. She’s great, really.
I can’t get anything done nowadays. There’s something happening every weekend, and on weekdays sleep > studying. And still haven’t found a COFM patient. And there’s still patho.
Doing OT3 has been like uncovering an iceberg.
