tamponade

It's been a week of ups and downs. Mostly tapering off to an equivocal feeling of ambivalence.

Emed posting test is over, but the worst is yet to come -- TEN WRITE UPS. All to be handwritten and completed on top of the radiology posting next week. Gargh. And I thought radio was gonna be fun and slack. We're posted to TTS H (by far my favorite teaching hospital) and back in gen surg days (almost a year ago!!), the radio department head promised us an excellent teaching program should we get posted there :) And so we are! Most exciting.

Am torn -- wish to have a dodiddly drink (or twelve) with a bunch of beloveds. But on the other hand... there's the radiology posting to think of (too precious to waste wasted), so it'll have to be next weekend if it's to be. Never liked celebrating birthdays belatedly, but we'll see :)

It feels like we've finally got a break now. Emed was damned exhausting. Not to mention, final exams just 2 days before the emed posting... Burned out. It was great though. Emergency medicine is helluvalotta fun, for a medical student anyway. Doubt it'd be as fun if it were a permanent post. The hours are just too insane, adrenaline rushes to power you through notwithstanding.

papa don't preach

I spent a day last week shopping with Dad. And like everybody else, he wanted the lowdown on what it was like "experiencing death firsthand". And I found myself being all blase about the emotional intensity of it all, simply because it was an off day (we were shopping for goodness sake) and I really didn't want to rehash all the issues I'd already dealt with countless times over.

Only to have him, with good intent of course, preach to me about the importance of "staying human" and being "respectful". Which really got me mad, though I tried my best not to show it, because it's people who make a big gruesome show of feeling 'heartache' that feel it least (well to be fair, most times anyway), and I really didn't think that preaching to somebody about "having a heart" would induce the growth of one if someone were heartless to begin with.

These things, you either feel them or you don't. And if you don't, that's probably so much the better for you because you go about your job without being emotionally burdened I suppose, and it doesn't make you any less human (or does it), and only becomes bad I think when you start showing disrespect. But if you feel them, surely you wouldn't want your feelings put on display for the world to dissect? I don't, at any rate.

So I don't blame doctors for 'making light' of the situation (not hilariously you understand, just not over-emphasising the sadness of things), because the tragedy speaks for itself. And going on about 'how sad things are' would be stating the obvious and would really grate on everyone's raw nerves. Also to be fair, they've been through it so many times, they're accustomed to the sadness. Not numb, just that they've learnt to cope with it. I haven't yet, but someday I will probably. If not, how?

heavy

Secrets.

Despite appearances to the contrary (yah la I very kaypoh but then) I hate being told secrets. Because I hate keeping secrets. Especially ones that plague me, and especially when I can't offer any useful counsel. But I suppose I've learnt over the years that sometimes, just being there and lending an ear or a shoulder's enough. The comfort provided is sustenance in itself and a lot of the time, most people don't seek advice, but an outlet for their emotional burdens.

I hate this secret I've been told, because while I always suspected, it sucks having my odious suspicions confirmed. Of course I shan't love you any less, for how could I? You will always be beloved, only I wish you weren't after all, because life is so much harder when one falls by the wayside. But you have my ears and shoulders, and all my love. And I shall never ever not be there for you. I love you.

300 and 10

I watched 300 today, because I love movies like that. Greek tragedies. I love them. Bravery, balls, bloodshed, beefcakes... bring 'em on!! Lest you think me a horny unfeeling freak of feminine nature, let me just say I feel incredibly sad too, when someone loses a husband, a father, a son and a friend. I have a heart, a big BIG heart!!

: ) Did I mention that doing emed at SGH, apart from the excellent classes and patients, also includes TEN WRITE-UPS??? Major screwage. And I should say -- all other hospitals only need ONE write up. Not even plural -- write UP. They suck. And I haven't even finished one. And I want to watch 300 all over again!!! And buy the soundtrack!

regressing

A few nights ago I had a really good dream, and the feeling from which I have kept for the past few days since.

Details elude me, but I recall crying harder than I ever had, and a big ogre rocked me like a neonate and comforted me till sobbing subsided into hiccups and hiccups into an occassional sniffle and I fell into peaceful slumber eventually. After which I woke up in on a bed of sponge with a cockatoo screeching in my ear.

I have a most annoying but ultimately indispensable alarm clock.

comfort, depravity

I find the singlet-under-workshirt thing rather comforting. You know, the retro white singlet worn inside a thin-ish almost translucent shirt (usually white/shortsleeved) and seen frequently on oldish gentlemen. They remind me of my gong gong, who used to dress up just so whenever he took me out. And of days when I was taken care of :) and hadn't a decision to make in the world except "no I wouldn't eat those vegetables!".

Was rather put out yesterday. Spent the night at the firestation and it was pretty much a wash. Nothing going. But that aside, earlier in the day, an old man who was more dead than alive was admitted for severe dehydration and malnutrition. The farang doc who got me to assist asked me for a spot diagnosis and I said terminal cancer seeing as how cachexic (i.e. skeletal) the patient was. And he made me feel really small when he asked if that was all I could think of, and ended by telling me this gentlemen was dying from neglect. He hadn't eaten or drunk anything in almost two weeks and this was despite him living with his very normal 40 year old daughter. To prove his point, he began giving an anatomy lesson, pointing out various landmarks and bony prominences, musculature (however atrophied) etc. The poor soul was barely alive, puffing on air as opposed to breathing, and when we inserted a plug to draw some blood, his veins were painfully thin so it must have hurt but he couldn't do more than wrinkle his eyes a little in pain. "How could anybody do this?" was a question that I no longer cared to find the answer to, and it hit home that human nature and its depravity is no longer a surprise. Resigned, not cynical, and there really isn't much point pondering the answer to a question which would solve nobody's problems.

My eyeballs feel heavy so often now, but they only redden and tears don't fall.

solo

Spent Saturday in the ED. Set up some IV plugs (am far from expert, but am gradually improving and most importantly, getting over the phobia of setting them up), took blood gave drugs, did CPR (managed to revive the asystolic gentleman, but he was clinically brain dead I think -- his pupils were not responsive), saw a patient with uraemic urticaria and anasarca, another with Bell's palsy, and many patients with chest pain (one of the most frequent complaints in the ED), breathlessness, a few road traffic accidents, and a motorcyclist who got stung by a bee and suffered some allergic reactions (not yet anaphylaxis). It was alright I suppose... it felt a lot like learning by osmosis. You hang around, pick up some new things and pray you retain it.

Some issues I never really had to think about but was forced to, inevitably now that we're into our A&E posting. If a patient with multiple morbidities is plunged into asystole (aka flatline on the ECG), would you want to revive him knowing that he's been asystolic for at least 10 minutes and that he would probably be brain dead because of prolonged lack of cerebral perfusion? I am torn between saying no, I wouldn't think it wise to revive him, since even if he were brought back, he'd be a living breathing vegetable or at best, a mentally impaired handicapped patient. But then I think if this were to happen to any of my loved ones (also assuming that they wouldn't have multiple morbidities), I would without a doubt fight to bring them back, braindead or not, because I wouldn't be able to handle the grief, the suddeness of the loss. I would want to hold their hand and say my farewell, and hug them one last time.

As I held his hand today, I wondered what he'd been doing before his collapse -- removing his prosthesis? having coffee? picking his nose? watching the telly? His hand was cold, but shortly after, he was maintaining a reasonable blood pressure and heart rate, so we knew that while brain dead, he would be holding on for a few hours to a few days, which led us to question the necessity of prolonging all this in the first place. I feel the only value, and such a value, of reviving somebody like the gentleman above would have to be for the sake of the people he'd left behind. Given 5 hours to say goodbye would undoubtedly be much easier on the heart than given no time at all.

tribute to china

I love the squelchy sound of my bargain rubber retro bronze ballet flats. I love walking round in them knowing what a bargain they were and being able to trash 'em without having my conscience smote me. I walk them through rain, drive in them, wear them with pants and dresses and srcubs and squiggle my toes in 'em when they start aching from all that standing around the ED and when I need to keep awake on my feet.

vacuum

I need a pocket of time, so I can head off to do what I want to do in the way of 'relaxing' and not have to worry about time flying past and all too soon, having to attend another tutorial (on ECGs for which I am most ill-prepared) or attending the crush in the Emergency Room. It's just too much too soon! Much as I love madness and adrenalin and action in general, I love sleeping late on weekends, aimless drives, watching dvds and most importantly, reading my Books too. Went positively mad at the Kino Sale last weekend and am almost a dozen books richer : ) I love Georgette Heyer!

It's now 12am and despite being completely bushed, I am going to drag my sorry arse through Prof Chia BL's ECG textbook (mostly too cheem but no choice) because I've not done it and we're having another ECG tutorial tomorrow and I'm feeling a lot behind. It's been only a week since the last time I crammed my brains for Finals but it feels like a month since. So much has happened!

The thing about clinical based learning is that everybody's always jostling for patients to clerk (aka study) because what you learn is basically what you get from the patients you attend to. And I can't even set an IV drip or plug and I've done practically zero procedures (basically all the crap you have to do as a houseman which you're supposed to start practicing now) so I'm thinking I'll have to head back on Sundays too. It's just too crowded with students on weekdays and saturday. Am stuck with a pretty on bunch of fellow meddies this time round :)

The ambulance run was eventful. We had many calls, mostly people falling and hitting their heads or suffering fits. It was fun, but the waiting wasn't. Nor were the humsup firemen!! Gargh. Administering CPR will only ever be 'fine' in an emergency -- all that humping and pumping is just ... awkward for girls when we have to do it for practice. And worse than awkward when we have to do it with an all male team of paramedics.

bubble bubble

I love Emergency Medicine (henceforth to be known as Emed)!

Well, what I've seen of it so far anyway :) Am posted to SG H which is turning out to be great despite the crampiness of the A&E department (it's literally bursting at the seams), because the Emed student itenary there is so well organized and we have (thank God!) a wonderful excellent Prof in charge of things. He's so obliging, planned in advance all possible tutorials he could fit into his schedule and is most reassuring and nice. People underrate niceness a lot, and sometimes, just being around somebody nice makes everything easy breezy and so much less insurmountable. Thank goodness we've just finished up pharmacology too. At least the drugs're somewhat familiar and we won't look a fool trying to fib our way out of things :)

That's the wonderful thing about med I think. It's (most times anyway) an environment most conducive to learning and studying because nobody has any airs at all and when they aren't too busy they're almost always obliging enough to teach you something. May not be what you're looking for, but it's something useful just the same :) I love Emed too because it's effects are so tangible. Talk about being on the frontline. This is it, baby.

Tomorrow, I'll be on an 'Ambulance Run' at the Alexandra Firestation. Wonder if that'll be eventful :) Off to hunt down suitable footwear. Haven't worn sneakers outside of school since '97!

manic

Minus the minute possibility of something going entirely wrong (e.g. our answers disappearing from our scripts), we are now officially done with year 3 and 2 days from starting our new A&E posting for our 4th year of medschool! No, we don't get a break yet. But I'm definitely considering Italy in June.

Yes, time bloody flies and it's just unbelievably exciting. I fucking love my life. It's manic ... the days (esp the day) before any major exam and I swear we reach new stress heights every time, just set you up for wonderful weeks of partying later. It's such a tumultuous, crazy, wonderful, exciting, killer cycle of events that I think doctors must lead the most extreme, if not fulfilling, lives because when you're working you're working for something worthwhile, and when you finally squeeze some precious time aside to hang out, it's just so much better because it's such a rarity you can't ever take it for granted.

I've dropped 10 pounds over the last 2 weeks so I think it's time I put some calories back in me : ) Beef steaks and burgundy, I'm coming!!

"two more pleeeease!"

i lay me

Today, I thought: If I died and all I ever was this life was a doctor, and a damned good one, that'd be enough.