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Thursday, April 05, 2007

Seems like I haven't written for ages! And it feels like that too! Every time I want to note an entry down, something always crops up though, and I put it off till later on, every single time. Procrastination is the bane of my life. =P

Now, before I head out for Easter celebrations, I thought I might as well jot something down then. Lots of changes have happened. Now I have changed rotation yet again, and have now started A+E. Only thing is that I'm on leave for this first 3 days, apart from A+E induction on the first day for 2 hours. =) And on that day, I got recruited for locum for this weekend! Guess it is because it is the weekend, that is why many people don't want to do it, I suppose. Better for me, I guess. So, in other words, I'll have a baptism of fire! Let's hope I learn it quick! =p


MRCS Exams

Seeing as how much I have complained previously with regards to my on-calls (in case it wasn't said, I did continuous on-calls over xmas and new year weekend, and all throughout December), I didn't have much time to study. Luckily, I started read a little a month before the exam, and the last 2 weeks of January, I just tried cramming it in,especially with the landlord doing work on the house during that time, that wasn't conducive to studying at all. Not having much hope, I didn't go into the exam with much hope of passing, given the little amount of time I took to prepare, I didn't feel prepared at all. But lo and behold, the one above was smiling down on me. And finding out my results just before I went back home, that was a nice and welcome surprise. =)


General Surgery

When I first swapped over from Trauma & Orthopaedics to General Surgery in December, I was on-call for the first day of the changeover, for the first weekend, then soon on to a set of nights at St Helier’s for the Xmas and Boxing Day week, then the New Year weekend day time, and finally on-call on New Year’s Day itself.

That on-call on the first day was a bit of a shock, as I did not know what to expect, and my brain was still addled with Orthopaedics stuff. I was not sure about General Surgery stuff at all, and add to that, I was missing my team in Orthopaedics. In addition, that day was busy as well, and I was expected to assist in theatre. As with all things, it took time for me to adjust to General Surgery, but ultimately, I got the hang of the on-calls, and actually looked forward to the next time I was on-call!

That 14 day stretch over Xmas and New Year was taking it a bit too much. I got really ill on my 2nd last night. Actually, I was ill 2-3 days prior to that, but I sniffled my way through and just took paracetamol and just got on with the work. However, on that 2nd last night, thank goodness it was quieter than the previous days, and therefore I managed to get a bit of sleep, although according to the medical team (which included the SHO and the reg), they said I looked like hell and sounded like hell (because I had lost my voice and was coughing and sniffling all over the place). The cruncher was that night, when I ran a high fever of about 39 degrees, and lost my voice totally. And it didn’t even come back for 4 days, despite lots of water and honey and Beecham’s concoction!

On the other hand, that whole stretch taught me a lot of things. I like the night shifts, especially over the festive season, as you get to see the emotional aspect of humanity again. People are actually nice, and there are no boundaries of being a doctor or a nurse. Everyone enjoys the season as it is. It doesn’t take much effort to smile and be nice. I like working on my own, to deduce and manage the problem. That is not to say, NOT to call for help when needed, but to recognise WHEN to call for help, and where your limits lie. I have had to deal with acutely ill patients when my registrar is off-site, in the wee hours of the morning. Because I am the only surgeon on-site, I need to be resourceful and have to make quick decisions on how to deal with the patient (as well as their relatives), getting the other teams such as the ITU or medical teams involved ASAP, and knowing when to call the registrar in to assess the patient, because I think that the patient needs surgery, or when to call the registrar for advice only. I know that sometimes, we feel bad or embarrassed for waking our seniors up, especially if it is for something simple such as reassurance or confirmation that what you are doing is the right thing. This is because we are afraid that our seniors will think that we are total incompetent fools who know nothing, and that, in turn, determines their impression of us. That impression gives us a reputation amongst the rest of the registrars and consultants, as they would be more afraid to leave certain SHOs to deal with cases. However, I believe that a dose of common sense, plus the fact that if you are unsure about anything, to give the registrars a call. That should be the case, rather than just letting it be. They are on-call and contactable for a reason. I admit, it is a fine line to walk on, because patients’ lives are at stake.

One point to note, the bleep going off every 5 mins while you are trying to clerk in a patient, is extremely annoying and disrupting. Although the patient may be very understanding, I myself get annoyed, especially when the referrals from GPs are not warranted. Occasionally, I feel like throwing the bleep into the toilet bowl and flushing it down the toilet, or throwing it against the wall, and screaming at it to stop for just 5 mins and give me a breather, just for a 5 min break or for me to go to the toilet or to get a cup of tea. But patients do not get to see that side of me, as that is only in my dreams! Many a time, I do not get a chance to sit down or take a break, as the on-calls are really busy. As such, I have lost a bit of weight, as others have commented on. I have realised that this is bad for my own health. If I don’t take care of it, who is going to?

With regards to my daily routine, I attend clinics and theatre lists and ward rounds, and I enjoy them. I have had countless opportunities to assist in many basic operations and marvel at the anatomy of the human body, as although the anatomy is the same, each body is different. In recent months, I have had several chances to perform appendicectomies on my own, supervised, of course. I’m proud to say that those that I have done, the patients recovered uneventfully and the scar appears aesthetically pleasing, post-operatively. My record for an appendicectomy skin-to-skin is 27 mins! My youngest patient that I have done is a 5 ½ year old kid.

I have managed to do a couple of varicose veins, and am still getting the hang of it, as that area is so delicate that I am afraid to pierce any blood vessels, for fear that the patient bleeds out! But I’m getting there. I’ve also done umbilical hernia and open inguinal hernia repairs with mesh, which my consultant and registrar are quite happy with my technique, without them prompting me that much. I’m pleased to say that my timing for a mesh repair of an inguinal hernia, skin-to-skin, is 32 mins! Not too bad for a junior like me, I would think!

I know that surgery is not about timing. But I am pleased that not only my timing is acceptable, and in fact, quite good, I am also happy with the way the operation went and the quality of every step involved.


Going Back Home

It is always nice to be going back home. I kept on working and doing on-calls till the day I was about to leave. I made sure to pack the weekend before and do whatever shopping I needed to do for present-buying. That Thursday itself (which was the day I flew off), I went in for theatre in the morning, did the list, made sure the patients post-op was fine, then went home, did some last minute packing, then I left the house! My HO was kind enough to send me to the bus stop with all my luggage (I found out that one bus at the bus stop near my place goes to Heathrow!), and for the first time since I can remember, I took the bus to Heathrow, and it was faster than going by tube or train or cab! It only took 40 mins! Got on-board and off we went, back home, which I haven't been back in a year, so it was a welcome treat. Before boarding, met WL and his gf, who also took the same flight as I did.

Landing at Changi, it was a nice feeling of coming back home. It was great seeing my parents and my sisters and my doggie again, and I am thankful for the fact that they are all healthy and not much has changed.

Met Star and Wushu D, who came over to my house the night I landeded. It was great seeing them, and seeing her pregnant and them so radiant and loving with each other. =) All in all, it was a great time being back, especially during CNY. Met up with family and relatives and friends, and it was quite interesting how they all were surprised to see me back. Had a quarrel with mum on the first day though, and I was really peeved, especially since it's not lucky (yes, I'm kind of superstitious) to be quarrelling or having anything bad during the CNY period. The reason of why this happened? Mum misses me and wants me to come back home soon. This time, went out more often too. Met up with Dee several times, for dinner at Clarke Quay, or just hanging out. Went to MOS, St James to club. Mupps was kind enough to give me some pointers on interview skills (coz my presentation skills are atrocious), and it was a huge eye-opener. And met up with the friends who mattered to me the most, this time round.


Another Taster Week

As part of the Foundation Programme for F2s, we can choose to do a Taster Week in whatever which we are interested in, preferably in a specialty which we are not working in at the moment. Initially, I did my first Taster Week in Renal Transplant Surgery and Paediatric Surgery in November 2006.

This time I had arranged for a Taster Week in Ophthalmology. Why Ophthalmology? It is so different from General Surgery, something which I thought I wanted to go into, ever since I started General Surgery. That’s what some may say. However, I was always interested in Ophthalmology. I worked in an eye clinic before, and I am interested in eyes, but I have just not the opportunity to go further in eyes as I did not manage to get a job in Ophthalmology. So I thought, the best way to gain an insight into it would be to do a Taster Week in Ophthalmology.

Having arranged it beforehand, I found out that most of the consultants were away due to the Easter holiday. But one of the Ophthal regs, SH, was kind enough to let me shadow them as well as Ms JL, one of the consultants who does paediatric ophthalmology. They were both kind enough to let me shadow them in clinics and in theatre, and the experience was brilliant.

The week started off with a teaching session in the morning, where I met the registrar, and he was teaching the SHOs how to suture using the fine instruments, under the microscope. Considering that is the first time I have ever seen or handled such small and fine instruments, it was a first for me, but I managed to do it quite well! Even better than the other ophthalmology SHOs who have been doing this for a longer time than I have, according to the registrar. So yes, he was quite surprised by that.

That morning, we had a LASER session, followed by a retinal clinic that afternoon. During that day itself, I learnt to use the slit lamp and the sternometer (to measure intraocular pressures), and learnt to look at the cornea as well as using the magnifying glass to look at the back of the eye (retina). He was duly impressed that I had learnt how to use the equipment and got the hang of it quickly. Throughout the week, I shadowed for cataract clinics, children’s clinics where squints were dealt with as well as refractive errors, and glaucoma clinics. I have learnt how to calculate refractive errors as well as how to adjust for it, and the kinds of lenses they use. It is simply fascinating.

All throughout this week, I have gained a rapport with this registrar, who is extremely nice, keen to teach if you want to learn, very intelligent, and very encouraging. On the first day of the placement after clinic, while having a chat about what I want to do, I said that I am in general surgery at the moment, but I need to find a niche, a specialty which I will be able to excel in. He said to me that I would be good in anything that I want to do. I was surprised, because he is the fifth person to say that to me in the past 1 year. I really want to believe in it, and yet, I do not want to as well, because there is always the danger of becoming too complacent in whatever I am doing, and I do not want to get my head too big! I really want to believe in it on the other hand, as it gives me an idea that I am that good, and that I can be the best in my field, and therefore my patients will benefit the most from that. Ultimately, I believe what you are, is what you make yourself out to be. If you want to be the best, you can be. Having said that, there will always be someone better than you, so you have to strive to be better, but not let that competition overtake you to craziness and jealousy, but more of drive you to excellence.

SH was full of praise for me in front of Ms JL (which I didn’t realise that I had made such a good impression!) said that it was a pity that I did not apply for ophthalmology, as I had good hands and technically sound (just needs more practice), and the need to know more. Something to that extent. Ms JL actually agreed! But with this debacle of the MMC in the meantime, he advised me to get to know people and still be involved with ophthalmology, and to complete my MRCS since I am halfway there already (just left with one more part to go), and that can count as a point on my CV. Also, to continue with what I am doing in the meantime, and to try and apply next year under ST2, or again as an ST1, depending on what experience I have managed to gain throughout the year.


Interviews for the MMC

Scary. More later.


So this is a really long post, eh? Yeah... have to catch up somewhat la. =p