crossroads

I didn't know when I'd say this but I knew I'd say it sooner or later -- I'm gonna miss Neurology like crazy. Actually, NNI. I loved my NNI posting though

1) I felt stupid all day

2) I felt wicked all day

3) I never worked as hard as I'd intended

4) I still don't feel like I've learnt enough

mostly because the general culture in Neuro is pretty similar to that of paeds -- the people are just so eager to learn, so eager to share and so all round kind, generous and nice. And needless to say, bloody brilliant. They're awe-inspiring, and yet so down-to-earth. I've never met a department more eager to impart their wealth of knowledge, and in the most engaging way ever. They seriously do their best to decode a subject that is infamously confusing.

I'm stressed till breaking point. Things on the must-do list (we aren't even talking about the full to-do list here):

a) settle housing in New Haven

b) send off plans to Uncle Jack and Auntie Kay

c) NEURO CASE REPORT

d) pack my suitcase (gargh I hate winter)

e) spend time with daddy (he'll be in Taiwan when I return in June)

and so many things but those are the major stressors.

My tutor at Harvard's just coming back from Iraq (he went to the front because his son signed up for the Marines and he wanted to stand by him), and he's been obliging enough to allow me to reschedule my posting so I'll be completing the full 4 week rotation after all. Here's how things are shaping up:

Yale -- 6 April till 2 May

weekend getaway, new york

Harvard -- 5 May till 30 May

NYC till June 3 and then I'm finally back home. Will probably do a spot of travelling on the weekends, but that's still some time away and I'm just trying to sort out my housing at New Haven argh. To think -- I'm flying in less than a week and I've yet to pack or confirm my apartment. I hope to settle everything by tomorrow. Oh man this is so stressful.

Part of me wishes I had more time in Singapore (I especially want to extend my NNI neuro posting and do a gen med posting), but this experience will be simply invaluable. I think I'm just chicken at the heart of it all -- y'know, going solo and everything is really a little overwhelming. Am assuaging my conscience by continuing a gen med elective in June when I get home. Okay, 3 am. Bed and bath time. Been reading articles for my case report, and I'm blearyeyed now.

Please Lord. Make Monday a Good Day.

inventory; flight of ideas pressure of speech; help

The thing is I never admit things are bad until they stop being bad. Then I'll go "Oh man I was seriously depressed!" and revel in the fact that I'm not anymore. But with time I've grown to recognize those kind of symptoms and I think I'm going through a bad phase right now.

A bad phase involves bad sleep, bad eating habits, bad study habits and general "my life is directionless and I'm kinda feeling screwed" thoughts. Also, room is a mess, nails are chewed to the quick, feet are blistered, hair is limp, and car needs a wash.

Today (Happy Easter by the by) I attempted to address bits and pieces of those problems. I paid for a carwash, paid for a full pedicure and did some neurology reading while my toes were being shaped. I also put aside the necessary forms required for my new passport, and will fix that tomorrow so my tickets to NYC can be booked asap. I will call up Harvard one more time tomorrow to see how things are (big deal, I shan't go if it's too much trouble), confirm Yale accomodation via email, and mug like shit and get started on my neuro research write up.

Need to fix the bedroom it's such a horrendous mess. Wonder where that'll fit in. 2:30am now, rambling on and on... Need to get hair washed. Need serious help?

splash

Talk about plunging into the deep end! I've started Neurology, which is mindboggling.

First, a brief respite over the weekend. Got back early Saturday morning after a comfortable flight. Took the motion sickness pills at the start this time, so basically slept through the whole flight. Pre-check in, I was sweating in my pants as usual, praying my luggage would make it through without being taxed for overweightedness. Well, thanks to a very obliging and kindhearted guy at the counter, my 45kg suitcase made it through. It helped perhaps that the angmoh in front of me had no stuff to check in. So in total, I have purchased 15 kg worth of books!! Which I think I will put to good use :)

Spent Saturday reacclimatising to Singapore -- food, family, and good rest to get back to S'pore time. India's 2.5 hours behind, and it was pretty tough starting Monday at 715am.

In fact, we're starting at 715am for our entire Neurology posting, which sounds brutal but actually is a pretty great thing. My tutor, Dr LKE is a wonderful teacher -- very dedicated (he tries to meet us whenever he can, sometimes up to 3 times a day!!), and tries his utmost best to simplify concepts for us. Well, I find neurology incredibly confusing because I can't remember anything much about neuroanatomy and my physical examination skills need tonnes of brushing up. As I've said, we've been thrown into the deep end, and it's only day 2 but it feels like I've gone through a whole week of Neuro and am no where good yet!

I know this is a very empty post, but I would have more to write just that I just woke up and I need to bathe and get some reading done (it's 130am, and I've got to catch at least 2 hours of sleep or I'll really collapse tomorrow).

In other news -- I have realized that my blushes are better controlled now. It helps especially when I tell myself "This Is Not An Apocalypse" and "I Can Live Through Worse" when inconvenient people from the past suddenly sprout up in the lunch queue, or when put in the spot and failing to answer very basic questions.

I don't care. I'm going to be kickass at Neuro even if it kills me! Ganbatte!

india, ten

Have almost finished saying goodbye. Only Prof Sunil left to find (may not be able to after all), and some forms to sign, certificates to collect, photos to take, toiletries and random bits to pack, and I'll be off. Spent the morning in the operating theatre observing a right hemicolectomy. I'd seen the patient in clinic when she first presented with anemia and intestinal obstruction, then in the wards, and now on the table. The tumour was massive, encroaching into the retroperitoneal structures and with widespread lymph node involvement. They took ages to mobilize it and when it finally came out I think it weighed a good 3kg. It was a monstrous, bloody, polypoid fungating mass that looked positively malignant. I shan't be around when they break her prognosis to her, and I don't know if I'm sad or relieved. Another operation coming up -- total gastrectomy for a 52yearold man with a loving family. He's got advanced gastric cancer, but hasn't been told his prognosis either. They think it's around 1.5 years, but God-willing, who knows how much more time he has? He was very nervous heading into the operation, and his family were clearly trying to be strong for his sake though they were distraught. Well, he's in great hands, for which I am glad.

Yesterday I discovered the deliciousness that is the egg and cheese sandwich at the college canteen. For all of 25Rupees (About S$0.90), you get a fantastic toasted sandwich packed with one layer of greasy filled cheesy goodness and another layer of omelette fried to perfection. Combine that with a subtle hint of fatfilled butter and some spicy ketchup, and it's absolutely divine. It's a lovely change from Indian cuisine (much as I've enjoyed it). I shall be packing that for lunch in the car (one for me and another for Mr Krishnamurthy, an adorable old fella who always asks my permission before he whips off his chauffer's cap heehee), although I think it wouldn't taste half so good as it would have fresh.

It was a strange cycle today. Dr A G (the outgoing HOD as mentioned in previous entries), also had her last day at CMC today. We chatted for some time, and in her I find a somewhat kindred spirit. And in some strange karmic way, it seems like we're both on the same path, just at different ends of the cycle. She's heading into retirement having enjoyed a wonderful and rewarding career and also having time on the side to get married to a lovely man and have two lovely daughters, while I'm heading into the end of my undergraduate course with the rest of life ahead of me. And we both start our new beginnings the same day. I wonder :)

india, nine

It's 10pm Vellore time. I've just wrapped up evening rounds with the surgery teams I'll be following into theatre tomorrow, checking out the patients pre-op (the best time to examine them because they have florid signs). It's my last night, and I simply can't believe it is.

I spent the morning with aforementioned Dr A G (outgoing HOD for Medicine 3) at a secondary hospital called Karigiri, situated some 10km off CMC. It was lovely. A charming new building, well constructed with great planning on the inside, which was breezy and open and very quaint. It's the community health centre, sort of like the polyclinic concept. You get some basic (well a little more than basic!) labwork that can be done onsite, and GPs to consult you and refer you to the main hospital when necessary. It serves the village folk who can't necessarily afford the outpatient fees at CMC. It's Dr A's pet project, post-retirement I think :) It was odd, going back to Medicine after having immersed myself in Surgery, but I learnt a whole lot. We saw the usual patients with hypertension and diabetes, but with Dr A, I realize there's always something more that I didn't know before, something more to learn. It's never-ending, for which I am so glad :) It would suck it things were static! As we made our way to Karigiri, we passed by bits of Vellore I hadn't yet seen -- the river without water, VIT (Vellore Institute of Technology apparently world famous), and some very good road. But it looked pretty much the same as the rest of Vellore. Will try posting up pictures once I get back.

I tried taking as many pictures as I could today, realizing that it's probably my last chance to. But pictures are but a poor substitute for the real memory. Someone once said that the memories you really treasure are those you keep in mind without needing photos (okay so they said it more eloquently). Well true to some extent. But photos do help someone with poor faculties (like me).

Anyway, I'm a little bummed I shan't be able to follow Prof Sunil's clinic tomorrow because I'll be leaving for Chennai a little earlier than anticipated to get some last minute shopping done. But in all practicality, I would've only been able to attend 45mins of his clinic anyway, which wouldn't have amounted to anything much save the fact that I could have said goodbye properly. He's arguably my favorite surgery tutor (and he wasn't even in the team I was assigned!). I'd basically been hijacking clinics run by all the various surgery teams (6 in all) to get a better grasp of the subject and to see a wider range of cases :) Oh the things I've seen! My list needs updating... which I hope I'll find time to do back home.

I have so much more to say. I think I would cry if I had any energy left but it's been a long day and I've yet to pack. For now, I'll put a fullstop because the bus is coming. But suffice to say, I shall miss this place dreadfully (yes I know I've said that lots of times).

india, eight

Just finished a 3 hour subtotal gastrectomy op. Spent all of it on my feet, which wouldn't have been so exhausting had I been doing anything constructive. The hardest part about being a surgical intern is the inactivity involved when one stands in for operations. It's like watching a movie in a foreign language, with barely any climaxes or plot twists, and all this done standing in a very itchy garment. I didn't scrub in today (scrubbing in means we don sterile gowns and gloves and can then actually partake in mundane chores like retracting the abdomen, making a few cuts and sutures etc -- i.e. better than nothing!), because I'd entered later than the start time after spending the morning doing Grand Rounds at the Medicine side. I wouldn't miss those for the world :) Many more things I've seen today, but I'm realizing that my reading can't keep up with everything I'm seeing. 4 weeks at CMC is just about right I suppose -- time to get serious reading done when I reach home to Singapore. One can only absorb so much!

Ah yes. Chennai. I spent Sunday in Chennai, shopping a little. The main shopping I did was for gifts for my tutors (I settled for traditional Indian candy from a very respectable, non-touristy boutique shoppe). Other bits of shopping were for clothing at FabIndia, a somewhat touristy place (you can imagine expats shopping there -- feels a little like Holland V back home) but very nice just the same. The prices are simply unbelievable. For about S$70, I bought myself 2 gorgeous cotton "mang" tops (stiff gauze-like shirts that are delightfully crisp), 2 long skirts (great fabric, easy to wear) and a pair of salwar pants (loose-fitting traditional Indian pants). I would've bought souvenirs only there wasn't anything very pretty. I also visited Landmark, which is a bookstore chain much like Timse or Borders back home. The books here are a fraction of the cost compared to Spore prices and I had a blast browsing :) The highlight though, was lunch at the Sheraton Chola with Mr and Mrs P, friends of the family. It was the best meal I've had since I came, comprising delightful Northern Indian cuisine, which is a lot lighter and somewhat tastier than South Indian cuisine (in my opinion). We had tandoori chicken which was perfection and I had a WHOLE FISH to myself, done tandoori style too (i.e. similar to bbq), with scrumptious dips and yoghurt and pan and naan. We finished with kulfi, a custard-like cold dessert. It was divine :) My tummy hadn't felt so satiated in ages. Oh my goodness I have almost had it with the South Indian food. You don't get ANY vegetables (they're all mushed up!), it's all carbs, the meat when available is so super greasy, and curries while nice are too jelat when eaten everyday.

I've almost finished writing my thank you cards (almost 30 in all), and as I write each one, my heart twinges a little more. I can't believe it's 4 days till I'm home. Time just zoomed by.

india, seven

It's funny, surfing the Sartorialist (thesartoralist.blogspot.com) in Vellore. Clothes don't seem so important here -- fashion and trends I mean. As I've mentioned, everybody's in traditional garb. I always marvel at how every woman is so well put together. Their saris are made of fabric of all textures and colours, and it is always perfectly matched with the little cropped-top they wear on the inside. India is generally a very colourful place. It is exotic, without trying to be, and a very earthy place. Earthy... I suppose I mean sensual really :) Women are women and men are men -- traditional gender roles are pretty much the rule here.

Am wrapping up now. Will be doing call tonight (which will hopefully prove interesting!) and have spent a most productive day in clinic today with a lovely helpful tutor :) which is the only reason why I am spending the night in hospital despite having to haul ass to Chennai tomorrow. It's not often one finds so willing a teacher! I can't think of any one particular reason why I'm going to Chennai. Above all else, it'll probably be a break sort of, which will lend me some perspective. It's very easy to lose oneself when one spends 24/7 in hospital as I've been doing. I can't imagine doing this (staying in CMC) all my life, practically speaking (because life seems to have other things in store for me). But honestly, I think if I had to, I wouldn't mind. I know now, how much I love my work :) I've received so much encouragement here both from the doctors and even on a spiritual level, that this really will provide me with the motivation to keep striving for improvement, if not Perfection. I never felt so charged up about things as I have here in Vellore. Medicine here is so... Real, so pure. People are treated because they need to be, and there is no bullshit. Investigations are ordered and diagnostic tests done because there is good reason for them, not to make quick bucks or because the clinician doesn't know better. You can't pay? Pay what you can -- I mean it. The doctors are forever writing off bills here. They NEVER reject a patient simply because they can't afford treatment. You're ill, you're treated. No questions asked. There's also this scheme in CMC called PTP (patient-to-patient), where a patient who can afford to, is offered the opportunity to offset the financial burden of a patient who can't. Where else would something like this exist?

I only pray this newfound verve will stay with me, even as I return home to comfort and ease and luxury. How I shall miss this place!!!