india, six

So I've started Surgery proper. It's a whole different world from Medicine is all I can say. And my gosh the tutorials here are simply amazing. We had multiple thyroid tutorials yesterday, and one of the tutorials featured FIVE thyroids and one insulinoma (which is so rare I think they've only ever had 30 cases in CMC!). I kid you not. F-I-V-E thyroids. Everything from Graves (with eye signs!!), to Papillary CA with lymph node involvement, solitary thyroid nodules, fixed thyroid nodules, multinodular goitres... basically the entire spectrum of thyroid pathology. I thought I knew thyroid inside out after TWO freaking tutorials, but the third tutorial by the HOD for Endocrine surgery was just MIND-BLOWING. Literally. I could feel my brain being blown off my head by all the subtle facts and stuff. You'd think by now we'd have nothing more to add to our fundamentals. IT'S ENDLESS!

I've also had my first medicine tutorial (which was on generalized lymphadenopathy, see below), which was mindblowing too, but not really up there on the richter scale with the 5-thyroid tut. I suppose it's because Medicine rounds are mindblowing enough, so you kind of go into a tutorial with the same level of expectation. I love it. Rounds, by the by, are when the doctors go round visiting all the patients in the ward every morning, to review their cases and discuss their managements etc.

Surgery rounds are pretty cool too. But only the Grand Rounds because I think you actually learn something then. They put us in a spot and grill us for answers. Daily rounds are mundane, unlike Medicine rounds where everyday there's something new to learn. Case in point. I went for Medicine Grand Round today (the mother of all rounds) and THE CASE LOAD WAS JUST OUT OF THIS WORLD. We had generalized lymphadenopathy (including epitrochlear nodes! I'd never known of their existence before today omg), brain abscesses, pericardial effusions, chronic interstitial lung diseases, Type II respi failure with unknown cause... OH MY GOSH. There's just so much to learn I can't get enough of things! While I'm in the midst of all this I don't feel like it's a lot, but when I type it all out it's immense. I NEED TO READ!

Speaking of reading. I have been Balaji Book House's best customer in recent times. I think I've bought at least 10kg worth of books -- most of which I'll NEVER find back home because they're written by Indian authors (amazing stuff), and the others I bought at prices which are simply unbelievable. At least 50% off the Singapore price tags! And you can bargain too :)

I'll be heading to Chennai on Sunday on a day's excursion, principally to purchase gifts for my tutors. It'll be a nice break, as Sundays aren't all that productive in hospital (as I found out last week). I slept really well for the first time last night -- think it's the product of too many sleep-interrupted nights and sheer exhaustion post 5-thyroid tutorial.

I miss all of you so much, but I know I'll miss CMC hell a lot too, so I'm making the most of every moment :)

india, five

I think the turning point came when I was so shagged, I simply rested my head in my arms on a table in Casualty (the CMC equivalent of A&E Dept) that still bore evidence of a recent blood spill, some bits of vomit and other random shit from orifices that don't see the light of day and took a deep breath. This is incontrovertible proof that I have acclimatised to my new environs. The dirt doesn't bother me so much, I use clorhex handrub as an afterthought more so than as a reflex, I don't mind touching footsores, don't mind leaning against the dusty walls, have given up checking the bottom of my basket of toiletries for mould, and have stopped spraying repellent (!!). And today, I finally found the courage to wear my sandals out (previously I'd been in my covered ballet flats). The one thing I haven't gotten used to though is the ants in my bedroom. WHERE THE HELL IS THE BLOODY ANT NEST? It's really irritating the crap out of me. Oh and the fan brokedown 2 nights back and I've been sleeping in dense heavy heat (the cool spell seems to have departed boohoo).

All that aside, I am STILL having the time of my life :) Was a little upset after a really unrewarding round at Cardiology clinic yesterday (3 hours of sheer boredom), but the rest of the day was super cool. Started surgery clinics (omg they are simply FABULOUS we see everything! and the consultants are so obliging they TEACH like amazingly well!! HEAVEN!!!), attending mini surgery lectures with the local students, and attending ward rounds in the evening with a new medical unit. Today I'm doing casualty with my medicine unit but it's too chaotic now and nobody's got time to answer questions so I'm doing research on some rare varicose vein inherited mutation disorder type thing in the library to prep for Vascular rounds. I'm very pleased with the exposure to Vascular surgery because I didn't get a rotation when I did my surgical posting back in Singapore.

I have massive amounts of reading to do (the more I read the more I realize how little I know) and I am greatly discovering my partiality toward Medicine. It's just a lot more interesting when read. But I suppose it's not fair to compare Surgery with Medicine that way because Surgery's a more hands-on, eyes-on affair. Talk about enjoying a handful and eyeful :) Have lots of interesting stuff to update my "Things I've Seen" List with. Heeheehee.

Am heartily sick of Indian food, savoury and scrumptious though it is. Mostly because it's very jelat to have curries all day long. I know I always end up talking about what I'm eating, but that's because I always blog around meal times. Think I'll have chapatti tonight. :) And can you believe domestic flight tickets in the USA are $2000?? It's gonna cost me that much to fly from philly to connecticut. Ridiculous.

india, four

Just wrapped up morning ronuds with the outgoing HOD, Dr AG and was pretty damned impressed. She's one of those outgoing happy people who don't deliberately put housemen on the spot but inadvertently wind up doing so when they ask questions. See super smart people don't realize that what they're asking isn't really all that easy to answer, so they expect you to do so and when you can't, they matter of factly state the answer and leave you feeling dumb. Unintentionally of course. She's well-read, so experienced and has great people skills. Also, a real sweetheart and so hip! Short pepper gray hair, chunky beaded necklace and kickass sari. Speaking of saris -- it's just such an odd garment, I can't decide if it's conservative or not. But more than anything, I think it's supposed to be sensual. And you know it's incredibly ironic how it's okay for ladies to walk around with their midribs (haha tummies mostly!) bare but not okay for them to wear sleeveless tops. Well, with the current weather, it's not likely anybody'd be exposing themselves indecently. It's getting pretty darn chilly -- about 19degrees maybe, and I need to sleep in long pants now. It warms up toward noon and is alright again till the sun sets. It's MBBS patients galore now, and I've made my appointment to see the surgery patients tomorrow after the exams finish, and the medicine patients either today or tomorrow. The trouble is, it's not really possible to take histories from them, so physical examination will have to suffice. Gotta go do some surgery reading tonight!

On Sunday, for the first time ever, I used the washing machine! I got up bright and early and decided to do my laundry before everybody else hogged the machine (we only get 4000l of water a day for the washing machine so I think that covers about 5 washes maybe?). It wasn't a disaster, which is most excellent :) I wonder if I should put more washing powder in next time though. I was afraid to overdo the washing powder and up with soapy clothes!

Another first on Sunday -- I headed to town. Although it was a little too hot for comfort and I headed back after a measly 2 hours, I took lots of pictures and pretty much saw the main shopping street and market. Lots of things are closed on Sunday (people really respect the Sabbath here). I bought 2 Indian tops that I can wear with pants/tights -- both to fit in with the general culture (everybody wears traditional clothing here, even the international students), and also in case my laundry turned out a disaster (see above). Visited the supermarket where I managed to buy some gummy bears (yayy!) and COKE LIGHT! Familiarised myself with the town bus route, which is pretty uncomplicated. I've been taking the college bus (the chartered bus that plies the campus and the hospital route) so as to avoid the crazy crowd on the townbus (see previous entries). Am glad that on Sundays, the buses aren't so crowded. I spied lots of little restaurants, and when I gather enough courage, I'm gonna have me a roadside mutton curry!! You see dinner walking along the street and it's a little disturbing -- little goats, some cows etc. But oh well. Like everything else, one becomes accustomed to such things.

india, three

I have never found a library so conducive to study as the Dodd Memorial Library at CMC. It is quiet, well-aerated, and despite the noise of construction that intermittently disturbs the peace, all is well. The selection of student-friendly textbooks is extensive and very satisfying. And of course, there is the computer lab at hand for quickchecks with wikipedia. It's Saturday evening now, but there is no where else in Vellore I would rather be.

The thing about being on one's own (entirely) is that there is plenty of time to reflect, complete autonomy over decisions regarding what to do with one's time (which is such a pleasure because having to come to a consensus is rather tedious sometimes), and well, complete Autonomy. Period. I love it. It has reinvigorated my thirst for knowledge and experience and learning. I haven't been so inspired in a long time. Think it might have begun with pathology, when things finally started coming together (albeit, not everything but just bits here and there). But the satisfaction one gets from understanding something makes it worth the effort it takes getting there. I can't begin to explain how wonderful it feels to wake up in the morning and head to this amazing hospital where patients abound, doctors are so willing to teach and everything is new. There's also no need to rush, no need to struggle with over-clerked patients ... it's like a buffet-in-wonderland.

I have seen much, though I would say it is different from doing an elective in Singapore because it's near impossible to take a history here. So physical examination and differential diagnoses become more of the tasks at hand. It has been almost a week, but I have seen nothing but the college campus and the hospital and Balaji bookstore across the road. Perhaps I'll go explore Vellore town tomorrow, if this fair weather holds. It was so hot and sticky when I'd first arrived, but is much cooler now. It even drizzled a little and there's a nice breeze in the afternoon. At night, it's cool enough that I need to drape my legs with a blanket.

Will go see the cor pulmonale patient that got warded from clinics now. And perhaps, catch the chicken biriyani for dinner :) This is truly, an experience to savour.

india, two

CMC is really amazing. Here everything superficial is ripped off the face of medicine -- you have world-class medicine being practiced in third-world conditions. It boils down to the brilliant medical practitioners and investigative procedures at the technological forefront. I still haven't gotten over how odd it is to see people coming in barefoot from rural villages all over India with a bagful of radiology reports and blood results slips. And the array of investigations available here surely isn't less than any tertiary institution in Singapore -- but you REALLY can't imagine all that stuff going on in this hospital which is like a throwback to World War II days. I'm not doing it justice by this haphazard explanation (really need to rush back to clinics soon) so I'm not gonna try anymore. It's simply awesome, and you have to be here to experience it firsthand to be blown away.

Anyway, speaking of brilliant practitioners. I've been in clinic all morning (till he decided he needed a coffee break) with the HOD and I've not said ANYTHING RIGHT. I can't see why -- I know the answers to the stuff he's asking just ... I'm coming across like a complete fool and I don't know why!! It's so irritating!!

Life is going better than ever, though I really miss Chinese Food! Have yet to venture outside the hospital, may do so this weekend. It's just that I can't bear to immerse myself in all the dust and dirt that is Town. It is so dusty here -- just being around outside leaves you coated in a thin film of dust.

Am heading to Yale for a Reproductive Endocrinology elective in April, which was the best Valentine's Day gift ever (they sent out the acceptances on Feb 14). I'm completely ecstatic (though initially it took awhile to sink in) simply because this was THE elective that I most wanted from the USA. Yale has one of the best obgyn centers in the states and I'd been hoping so much to do an obgyn elective overseas :) Okay, will update more but for now it's back to clinics!

India, one

Where to begin?

It's hot and extremely humid. The air is heavy and makes everything move so slowly. It's funny because I'm actually typing on a keyboard without any alphabets left on the keys -- we type blind mostly, but it's really weird not having any alphabets on the keyboard anyway. Thank goodness for a computer room though (the PCs are from the mid-90s).

Chennai went by in a blur because I took some sleeping tablets for the car ride to Vellore. The thing about travelling on the roads is everybody has their hand constantly on the horn so it's just such a racket it's unbelievable. I'm staying at the international students hostel on campus so it's pretty convenient. There's a grocery place, the principal's office is just down the dusty dirtroad and the college canteen is literally "25 steps away". So far I'm surviving on omelettes with ketchup. I miss wanton soup horribly and pei dan chok!! The tea is good though -- little shotglasses of what tastes like teh tarik. Money here is very small -- you can survive on 200rupees a day which is a little over 2USD. Culture shock came today though (not counting the general squallor) -- the townbus ride to the hospital.

I used to avoid buses 66 and 67 because they ply the Little India route but even those are nothing compared to the bus rides here. They are full to the max and there aren't any doors (I was standing AT the opening of the bus and had to try to stay on it). It's all open-windows on the buses, for which I am very grateful. Everybody's jammed against everybody on the buses but the people here are very respectful and friendly. The men aren't pervvy and they're all generous with directions and stuff. Nice :)

The famed Hospital. I felt very happy there, if not entirely at home yet (it's been one day after all). It's depressing at first, seeing all the people lying around the corridors barefoot but then you realize at least they'll not be turned away from this hospital and that's a wonderful thing. The wards are less bountiful than I'd thought but only because I haven't yet had a chance to explore the place fully (my team's off Monday afternoons since they work Saturdays). Am starting with General Medicine first and then General Surgery the last 2 weeks. The system is very similar to Singapore's -- consultant, reg, MO, HO. But their differential lists are amazing. All sorts of obscure stuff you see in med textbooks that don't ever cross the lips of the Singapore practitioners feature quite prominently in the case workup sheets. I'm lost. Need to do major reading. Esp on bloody hematology (even the Indian HOs agree hemato sucks!).

Will update more once I go check if they've fixed my shower (it was dribbling yesterday). In general, campus is a happy place, although it looks like a set from the 1960s. The dirt never fails to gross me out but I'm starting to notice it less. I was incredibly homesick yesterday but with time I guess that'll clear too. Am going to try the dosai for dinner.

my escape

It is with a somewhat heavy heart and with some unfinished business left that I've packed my suitcase (how I wish this were plural though) and await the flight to India. I'll be heading to Christian Medical College (CMC) in Vellore, India which is approximately 140km away from Chennai (the nearest available metropolis). Vellore, I understand, is an agricultural town with the hospital as its main attraction. Will share more when I've found out more upon arrival :)

To T, thank you so very much for being there for me. It's not very often that people move me to tears because of something they've done for me, but you were there when I had nobody else to call in that particular situation and for that I truly appreciate it. I owe you big Big. Y'know la. And I'm so sorry I got you in trouble, really truly I am. I would hate me if I were in your person's position, but because I'm me here, I'm giving my conscience a little break since 1) Nothing happened. 2) I had no evil thoughts in my brain (which in that frame of mind, probably was pretty much empty!). 3) I think your person would have done the same in my position because you're You.

Okay, I really hope my suitcase makes it through customs without being taxed. But seeing as how things have gone (pretty much cloudy) this CNY... :( Will keep you posted.

All my love.

humming along

Long ago, from a movie somewhere, someone said that when you finally say what you want to say at the time you want to say it, you'd feel simply awful.

It's something that I've always kept at the back of my mind. I'm the sort who gets tongue-tied when I get emotional -- pissed off, deliriously happy, heartbroken, whatever -- I just never find the words to express my feelings because they overwhelm me and I'm lost in the moment. It is only in retrospect (goodness knows how much I loathe retrospect-ing because it freaking wastes a whole lot of my time and makes me bloody pissed off at my ineptitude!!) that I finally find the perfect retort/reply. And I never fail to replay the scene in my head and imagine the satisfaction I would've gotten had I said just that just then.

Now, I've been given plenty opportunity to well, stick the knife in so to speak, these past few occasions. But because of said movie line, I've resisted any and all attempts (and trust me, they've been Incredibly tempting). I suppose you could say I'm not entirely heartless. Or you could also say I'm just a big coward afraid of confrontation. I hate being labelled The Baddie or The Bitch, although I often acknowledge to myself that I'm one nasty porcupine. It's one thing to prepare the perfect bitchy retort, and another to actually say it. The first preserves the peace, the second inflicts hurt all around. And there's no telling how things will play out in real life unscripted. So for now, while this volcano lies dormant, I shall keep all nasty thoughts to myself and imagine what it'd be like to boil nasty things in oil. And keep on grinning :)