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Friday, June 01, 2007 A+E I have just had 10 days off on ‘zero hours’ or annual leave. It was bliss, not having planned anything, not having to do anything. Usually, if I had more than a week off, I would have planned way in advance to go away, to go somewhere and get out of London, my house. But I guess, with this year and all that has been happening, I am really tired, mentally. I have been working hard, at doing well in my job, showing that I can be the best I know how, and understanding more about myself and pushing myself to the limits. Each time I get used to the job and can enjoy it for what it is worth and do it to the best of my ability be comfortable with it, I have to change placement again. And therein lies a cycle of getting to learn new things and getting used to the new environment again. Change happens, again. The first thing I noticed about A+E is that it is never-ending. Always continuous. That is a downside of it. Another is that although there is majors and minors sections, which are full of patients as it is, there is no paediatric bits to the job (as it is handled by the Paediatricians on the Heliers side). Thank goodness I have undergone Paediatrics and had the benefit of working in a Level 3 Neonatal Unit with brilliant colleagues, whom I have learnt a lot from during that period of time. On the other hand, it’s a great thing not having a bleep. Every time I was on-call and had a bleep, I was excited on one hand, but at the same time, the moment the bleep keeps on going off, I had the vision of just throwing the bleep into the toilet bowl or against the wall many times. But now that I do not have a bleep, I am savouring every minute of it. Also, I am thankful of the fact that I am still managing to see some patients who have surgical problems. I am also at Heliers, which was what I wanted and which I managed to arranged. Thank goodness for the swap, coz I think it is a blessing in disguise! I have now gone through almost 2 months of A+E, and I love every moment of it. I am learning lots. Learning how to deal with minors patients, re-learning medicine for majors patients, and even learning how to deal with resus calls. In the first 2-3 weeks, I was terrified of taking any resus calls, as it seems that all the middle grades are busy with everything and everyone else. So I didn’t volunteer, and it was like I was trying to cover up my fright by being busy with the majors patients. But now, I am not scared anymore, and am learning how to deal with such situations and taking it one step at a time. My colleagues too, both medical and administrative, are wonderful. My supervisors and regs are good and willing to teach, if we are willing to learn. I realise that we can learn a lot from one another, and I am talking about SHOs/F2s. Each of us has done different placements, or maybe we have done similar placements, but we each have different experiences. And although we are all very different people, we have similar mindsets, and that is, to recognise an ill patient, and to treat every patient to the best of our ability. :+: Courses I have just attended the Advanced Trauma and Life Support (ATLS) course at St Helier Hospital at the beginning of May 2007. It is a great course to go through, and the instructors were very hands-on, and built on a basic foundation. It helps that Mr Churchill and Dr Stevens, both my educational supervisors who are brilliant, are the course directors. I hold high regard for them as they have taught me a lot by example. Pre-course, I needed to read a humongous ATLS book for preparation of the course. Those 3 days of the course itself was amazing. It was very informative. Although one would have read the book beforehand, it never beats having the basic concepts drilled in to you and reiterated every so often, be it in lectures or in practical sessions. Not to mention, one does not realise that they are constantly under scrutiny by the course instructors, because they are not obvious at all. But it stands to hold that they observe you all the time, as the course is essential. One can be book-smart, and can pass the course easily at the written test or the moulage, but I feel that it is more of the consistency of throughout the whole course itself. Having said that, we went through the 2 mock test stations before having the actual moulage/test itself. During the mock stations, I feel that even though you know the basic concepts behind it, one is never totally prepared for the actual situation itself. Although I knew what I was supposed to do and look out for, it is so different despite speaking out loud during the exercise itself. It turned out to be so fast and so slow. Anyway, to sum it all, even though I passed the moulage and thought I did well in the written paper, I was wrong. I failed in the written paper, and got the lowest. Which even surprised my mentor (in the course) and myself. I lost a bit of confidence there, and just let it be for a couple of days. Then I re-sat the written paper a week and a half later, after reading the whole book again. And I passed, with a score of 36 out of 40! A great relief, that was for me. :+: What I have Learnt I have just finished a week of nights now. Altogether, I have done 2 sets of nights under A+E, and during these times, I wonder at the intelligence of the population which we are treating. I understand that people want to be seen by a doctor, and they have to wait. Some just can’t seem to comprehend that there are some others who are more ill than they are. Especially those in minors, where they complain that they are waiting so long to see someone, and that their problems are the most urgent. Compared with someone who has had a heart attack or an epileptic fit, in priority/resus, they don’t seem to comprehend that that is more urgent. That just irks me. Irritates and annoys me tremendously. I’ve learnt that, given a hard enough push, especially if it is unreasonable, I can lose my temper. I’ve come close to that a time or two through the week of nights, but I never have lost it. After a while, I just resign myself to the fact that some people are more selfish than others, and I just have to deal with it. And exercise my patience, something which I don't have a lot of. I have learnt lots in this rotation alone. A+E is never-ending, and I enjoy the variety of cases that come in. I relish the adrenaline rush with the priority and resus cases which come in as well, but I admit, I get scared at times of not being able to cope during the immediate management itself. Or getting access. Or not giving the right treatment. But I manage. And I know that there is always someone to ask, somewhere around in the department. But I’m also afraid of being seen as incompetent at times. I don’t want to be known as the ‘doctor who is useless’, or my colleagues just shaking their heads when they hear my name, as I have seen with some other doctors. I want them to be able to trust in me, that I am safe, reliable, and good enough for my level, if not better. Moreover, I have learnt that I work too hard at times, even continuously, and initially, forgetting to take my breaks. Until my regs order me to. And I think that is good. Those breaks are life-saving, if not, I feel so burnt out after a shift that I do not have the energy to do anything after that, and just crash at home. Then go back into work the next day. It is not healthy. And I have changed that. It is good that I have really good SHOs in the departments, who have done a variety of placements, and that vast experience pooled together, has helped in discussion of cases, and learning more about the management, and interacting with other colleagues, and having fun at the same time! This is with the nurses as well, and I get along well with most of them, even having a laugh at times! 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. :+: Interviews for the MMC Scary. More later. :+: So this is a really long post, eh? Yeah... have to catch up somewhat la. =p Sunday, January 07, 2007 The Longer you are away from home, the less frequently you miss home. However, when you do miss home, the feeling never lessens. In fact, the feeling of missing so great that at times, you wonder why you are here and why you aren't at home. Then, you wonder: where exactly is your home, now, at this present moment in time. You pause. And you say. Home will always be home. Home is where the heart is. Tuesday, January 02, 2007 It's been a very long time since I've updated, yeah? The inertia is too great most of the time, even though I feel like updating every single time. Call it inertia, or laziness, or ambivalence. Anyway, thought I'd better do it now, before everything becomes a haze in this fuzzy memory of mine! :+: Taster Week We have this thing in the Foundation Programme, where we are supposed to do a week in something other than the placement we are working in at the moment. It can be something which is arranged by the postgrad centre, or something we arrange ourselves, and hopefully it would be interesting for us. This is so as to give us a 'well-rounded, diversified' outlook on the other aspects of medicine. Had split my week into 2 parts - 3 days in one week, go back to work on thurs and friday (coz my boss was oncall those days and I wanted in on the clinics and trauma lists), and 2 days the following week. When I got back, was told I was sorely missed though. =p Anyway, back to the taster week. I did mine in a combination of both. Namely, it was partially something which I was allocated to, by the postgrad medical centre - Renal Transplant (under Mr Chemla, SHH), and something I arranged as well - Paediatric Surgery (under Ms Body, SGH). And it was brilliant! I got to do a couple of AV fistulae on lists, and go for clinics, got to do a circumcision on a kid (and that didn't turn out too badly!). Now I'm definitely more interested in vascular surgery. It's so intricate, delicate, fine-tuned to precision. I like the aim for perfection for it (if the vessel fails, that's it!). I'm still not so sure about Paediatric Surgery. Guess I have to do more of that before I decide. Then again, I love the kids. Still. Seriously miss them at times. =) Advanced Life Support In between the taster week, I had to go for the ALS course. Those who do A+E have to do it before they start A+E. I must say, the ALS course in Epsom is wicked. The instructors were fantastic, absolutely brilliant. We were split into small groups of 5-6, and there was a written exam, as well as mock scenario stations and on the final day, a scenario at the exam. As the team leader, you're under pressure to appoint people, make decisions on what has happened, what needs to be done, what are the causes of arrest and correct it, and keep on re-assessing, all the time staying calm. Or at least projecting a calm image, even though most of the time your mind screams 'I don't know what I'm doing or what I'm looking for!' (which mine does at any point) or your non-verbal communication (aka wringing your hands/fingers or scratching your neck or playing with your hair or just looking puzzled) tells it all. All in all, it was a great 2 days packed with lectures and scenarios and lovely instructors (some of whom were very good eye candy even though they are married) and group members. A must-do for anyone in the medical field really. And it is at the stage - just after PRHO. Very appropriate level, I think. The next one to get over would be the ATLS! :+: Things outside work Amongst other things, I was quite ill, towards the end of my week of nights. So much so that the medical SHO and lots of the nurses said that I should be at home resting, and not at work! See, it takes people to tell me repeatedly, before it registers in this brain of mine that I am actually sick and need to rest. And yep, I was down with the flu. It came on insidiously really, starting with a sore throat, then progressing to a cough which became worse and more productive every time I took cough linctus. And guess what. I lost my voice. for 3 days. 2 days before and after those days were interspersed with a hoarse (aka husky/sexy, as evidenced by the guys saying I'm gonna give them a run for their money) or croaking voice, which I still am sounding like, but at least now, I'm not hacking my lungs out, or waking up to bouts of coughing, which was rather painful. Literally. I'd much rather like it if I had the sniffles every now and then. It would take the edge off these occasions of sickness. You know, the last time I had something like this, was in March 06, where I actually had to take a sick day off. It's the same this time, and I had to take the last night off. The word - unbearable, comes to mind during those few days that it was getting worse. This was despite medications, and supposedly adequate rest. Guess that was my body's way of telling me that 7 days straight of on-calls doesn't agree with me and that it was time to take a rest. And so, that I did. The night I took off, out of the 24 hours in a day, I slept 18 hours of it! And the next few days, because it was the weekend, I had 12 hours each day! It was a great feeling not needing to wake up to the alarm, and to silence in the house (none of the housemates are around). And although I was oncall again yesterday, on new year's day, and we didn't finish till midnight, I was off again today, and slept till 11am, pottered around the house for a bit, then had a long nap in the afternoon. Indulgence, I tell you. =) Amongst the sickness, meet-ups with friends for dinner and drinks are the norm now, especially on thurs or fri nights. Oh yes! We had the Orthopaedic Xmas Dinner at Wimbledon Village, this posh place called the Lighthouse, which served really good food! Great service too. Then we headed to the club in Wimbledon and danced the night away with the boys and girl (apart from me, there was just Dominique)! It was great fun! Oh yes, we went for this MOH dinner networking thingmajig at the Singapore High Commission, in London. Where all the biggies were, and they were saying to go back home to work. It was catered more for the health professionals, specifically the docs really, the way the talks were geared. However, despite all these visits, which all sound the same btw, they can't give a good reason or an incentive for us to go back to work there, apart from that it's home. Anyway, enough of that for now. More later when I actually have the energy to write about general surgery and the oncalls I've been doing. It's just been manical. Sunday, November 19, 2006 A blast from the past... :+: 5 September 2006 Basic Surgical Skills I recently attended a course on Basic Surgical Skills on 15-17 November 2006, organised at Kingston Hospital. Before the course itself, the postgraduate centre sent us a pack, containing the participant handbook, as well the DVD to read and watch, before the course. However, nothing can prepare for you the course itself. With a timetable set out for the 3 days of the course, we knew what to expect for each day. There were 16 of us, from various hospitals all around the country, ranging from Brighton to Ireland. During the days, we would watch the DVD, stop and practise the skills shown, with the various instructors supervising. It was a standard timetable, really. On Day 1, we did theatre safety - gloves and handwashing, then we fiddled around with the surgical instruments, and practised our knots and ties, followed by learning about the different types of suturing techniques. After lunch, we handled pig tissues, trying to ligate blood vessels using the various techniques, before doing the ultimate of an end-to-end anastomosis and an end-to-side anastomosis! Day 1 was fantastic, as I learnt to perfect my knot-tying, as well as be ambidextrous with both knot-tying and handling instruments. It was exhilarating to know that both my anastomoses did not leak at all! Well, the end-to-end one had one leak (which was quickly corrected). Out of it all, I was the first to finish, and my ties looked pretty good and neat, if I do say so myself! Even the instructors were quite impressed. =) On Day 2, I had missed the video on Aberdeen knot (as we had arrived late due to the traffic jam), but we did an abdominal incision and closure. The thrilling part was when we did the arteriotomy and closure bit, as well as the vein patch grafting! It was an afternoon of trauma and orthopedics. We learnt about how to handle traumatised tissues (to take more is better than to leave some dead tissue in the region!) and debride it, as well as how to repair tendons, the principles of fracture management and complications, and we had a hands-on session with plastering as well as AO fixation with screws and plates. That was absolutely great, as we were not expecting to play around with drills and plates and screws. I must say, it feels good to actually have the drill in your hand and do the deed. The last day was concentrated on minimal access surgery. As usual, we watched the video/DVD on the principles of minimal access surgery, as well as the concepts of diathermy. We learnt about open and closed methods of port insertion and management, and did multiple exercises to demonstrate our grasping and manipulative skills, as well as advanced dexterity exercises where we were taught to clip and do a loop ligation as a simulation of an appendicectomy. I also learnt how to do a Roeder knot, as well as to tie a laparoscopic knot. Last but not least, we had the chicken skin peeling exercise, to see if we could handle the diathermy safely in the peritoneum. With a well-organised timetable, breakfast, lunch and refreshments provided at suitable times, it was a great experience to behold. The instructors have my utmost respect, as after this course, I have realised so many things. I came to this course with the aim of gaining an introduction to surgery, as well as learning about the different types of knots and getting a feel of whether it would be too technical a field for me to go into. I came out of the course, learning more about myself than I expected. I learnt that I prefer technicality. I love handling the drill and knowing what to do with screws and plates. I can be ambidextrous, especially with knot-tying, and it is not at all difficult, and I do not have to practice extra hard for that! I demand perfection from all that I do. Not only does my sutures need to be perfect, it also has to be done fast as well. I know that I am competitive, but with myself. I know that I am impatient, for wanting results, for wanting perfection, but I know it is good in a way, as it helps to better myself, and ultimately, it is good for the patient. But I’m not going to kill myself for it if it doesn’t go as planned. I was very pleased with my anastomoses – no leaks, neatly done and one of the fastest, surprisingly. My vein patch graft wasn’t as pretty, but it was functional. I must say, however, that vascular surgery is so very delicate. Scary. Had a chat with Mr Paul Thomas, who was my instructor for 2 out of the 3 days (and who incidentally works as a vascular surgeon at my hospital, so imagine my surprise and cringing when I saw him there at the course!), and he said that he was quite impressed with my skills. My dexterity with knots and the anastomoses was ‘impressive’, and that amongst all the participants at the course, ‘you were quite exceptional’. In terms of knots/sutures/veins, but not as fantastic as he expected with the laparoscopic stuff. I agree, but I still think I’m quite good (as compared to the others), in terms of handling the laparoscopic instrumentation and getting orientated in the field. All in all, this course has reinforced my belief that I actually am cut out for surgery, have the technical ability for it, and ultimately, I thrill in the enjoyment of it! :+: On-calls On anothe note, I have finished all my orthopedic on-calls, as of last tuesday! Have finally done my dues (especially after doing 3 weekends in a row in September, going for a 2 week break, then coming back to a 3-weekend simultaenous oncall in October - it can kill. Trust me. But... I've survived it all, and done all my on-calls at manic Heliers (now that all the trauma is diverted to from Epsom to Heliers). I've survived! Now, bliss for 3 weeks before swapping jobs in December and being on call for General Surgery (which I know nothing about) on the first day, as well as the first weekend. It's gonna be bad.... Sunday, November 05, 2006 Today is Guy Fawkes Day. Lots of Fireworks. Back in London And so, it has been decreed - I am back in London to work. Well, I'm actually on the border or London and Surrey now, and so they are more or less interchangeable. Sorry I haven't been able topost for a while. Have had a lot going on for the past few months actually, which I will try to go into in detail, bit by bit. :+: Work I have started working as an F2/SHO/MO1 in Trauma & Orthopedics at the moment. It is tough-going. Three months into it, I'm just about getting into the hang of it. It does help when I have quite a nice reg (both ex- and present) who are willing to teach, even though I ask lots of stupid questions and he (and everyone in the orthopedic department) thinks i'm most probably a nitwit. I've done my dues of having to do 3 weekends in a row as well as many many weekday oncalls, one after another, in the span of the first 2 months. I have also taken a break in the first 2 weeks of October, and come back on a Friday afternoon (after the flight is delayed from morning to afternoon), then started on a week of nights which was horrendous. Being handed over 5-10 patients from the day's take is not funny. Being handed over 2 sick patients with nothing done for them is not funny. It's just taking the piss. Following that, I did the weekend on Sat and Sun after finishing on Friday morning, sleeping the whole of Friday day time, and being crazy and manic on the weekend. That was fun. BUT... I've survived it all. I've done my dues for oncalls, and am just left with 3 more weekday oncalls. I'm glad that I know a little bit more about Orthopedics when I first started. And I have confidence that I can do an MUA or K wires or a DHS or a hemi on my own now! =D And I can safely say, I actually don't hate Orthopedics. In fact, I'm enjoying it! Being the only female SHO and the most junior one at that, gives some advantages and other disadvantages. We shall not go into that, but put it this way. I had to work doubly hard to be accepted, let alone for my opinions to be accepted. Think the SHO/couple of the Regs are trying on something more than work (on me). Enuff said. :+: End of Kent I've finished Neonates and Community Paeds in Medway. It was a great experience, and if given a choice, I would do neonatal ICU in a heartbeat. But now that I'm doing surgery now, I think it's really the thing for me. I've finished the Part 1 exams and passed them (bloody bugger, it was more difficult than finals!). Because it was towards the end of the F1 year and all of us were going separate ways, there were lots of leaving-dos and BBQs (given that it was summer), and we had the Summer Ball and the Boat trip (which went around the river in Maidstone), and it was just fantastic fun! The photos are out on my website, and it brings back so many lovely memories. So much so that during the first 2 weeks of my new job, I wanted to go back to the familiarity of Kent every day I finish. After the boat trip, hooked up with someone, on a temporary basis. Fun, I suppose, but it's quickly tiresome. During that last month, amongst work and all the leaving-do-dahs, plus a short trip to Dublin, I had to arrange for leave in my next job, and find a place to live in as well (looking at 15 places in a span of 2 days and deciding then and there is not joke), pack all my stuff (a pain in the arse - you never know how much rubbish you can accumulate in a year), bought a car, settle my car insurance, and move all my stuff from far-off Kent back to London, and get used to the new area that I moved into. All that in the span of a month. I'm proud of myself. :+: Trips Abroad I've been to the West coast (July 2005), the East coast (May 2006) of the States now. Went to Dublin in July 2006, then I just came back from Russia and Finland and Sweden this October. A similar period to last year, October 2005, where I went to Eastern Europe (Prague, Poland and Hungary). Next trip? Back to good old home in Feb 2007 for CNY, and what next? Who knows.. More about the trip later and lots of photos!! :+: Meeting-up Amongst all the busy on-calls and essentially no-life for the past 3 months while trying to organise bank accounts and on-calls and get used to living in my new area, I realised that it's not enough just working. I need to have my life back. I need to have my sports back. After swimming almost every day in Kent in summer, and not having any outside sports in 2 months since my new job started has taken its toll. I needed something else. And therefore, I'm back to volleyball! =D It's been great going back to it again, especially when I'm playing with the teams again and competitions! In fact, due to my own stupidity at not warming up properly, think I sprained my wrist and therefore couldn't play in the match last week. Guess what happened then? I became the umpire instead! It's sooooo different being the umpire, unbiased. I realised that you just have to stick to your guns. I've gotten back to the routine of going for clinics, seeing my own patients and being confident of my own diagnoses and management plans. I'm happy doing theatre lists with my bosses as well, and am quite happy that they allow me to do more and more. My boss in fact, can make jokes (which he usually never does)! And we can actually share them and laugh at them! I've gotten back to meeting up with long-lost friends (neglected for the past year), and having dinners at their places/outside, and just catching up. Went out with my reg, Made new friends, and went a bit high this weekend as well. It was great fun. =) Celebrated Stan's birthday yesterday too at the Roadhouse in Covent Garden. The live band was absolutely brilliant! Would love to have my birthday there. =) Lots to say, not much time or inclination to type my most private thoughts out here. Surface to say, it's been eventfully unremarkable. Got to go now, but hope to put up my pics and stories soon! Catcha later on. Tuesday, July 11, 2006 Have to quickly type this before I log off. Know I haven't updated in ages - will have to at some point. Been busy, not as much as Medicine and Surgery in work, but still just as busy on settling other issues. My internet in the room hasn't been working for a week or so. - most important, I've finally found a place to live for next year, come August when I start my new job! Things to write about when I actually have the time to be on the internet for long! -East Coast, neonates, BBQ, finding a place to live in for Aug, leaving-dos, community paediatrics, etc... more later! the person is shooing me out of the library! Wednesday, May 03, 2006 Okay, this has been delayed much too long. When was the last time I wrote anything in here? Hmm... weeks... Anyway, while it is 12.30am on an early thursday morning, and while I'm listening to Underworld's 'Born Slippy', and yawning myself to tears, I've decided to bite the bullet and kick my butt out of inertia to write something in here. Considering I type faster than I think, this should be a walk in the park. *one can only hope* :+: Exams I've just taken the MRCS Part 1s at the end of April. Likelihood of passing: low. Studied, but didn't really concentrate and prepare really early. It took a while for the inertia to be kicked off, and for my brain to actually start working again. And so, I went into hibernation phase, and stayed in Kent on weekends, studying (or trying to at least, but not being very successful), and you know what, it was actually a pleasure. I felt relaxed, and actually relishing what I was reading through. When I was in the exam room, it felt like written finals all over again. I actually quite like the feeling. Made me feel at home. Somewhat. I know, I know. You must be thinking, why in the world would someone who has just finished finals not long ago, want to do more exams now? Well, it was an impromptu decision, of some sort. I put my application in in that last week of the deadline. Judging from the previous posts, Surgery seems to be the one for me. However, ever since being on Paeds, it has changed my perspective, and I've veered off-course slightly. I'm not having second thought about surgery, but now I've another very viable option to consider. We just have to wait and see, won't we? :+: Paediatrics I've changed rotations and started on Paediatrics aka little kiddies. Been on Paeds for just over a month now, and although I didn't really enjoy it initially, I'm now enjoying it so much more. Perhaps it is because I know my responsibilties now (even though we F1s are supposed to be supernumery, but circumstances has turned it 180 degrees around). Initially, AKF and I were just like supernumery house officers, not knowing how much we can do, or what exactly our responsibilities are. And so we dangled along in the first couple of weeks, doing what we normally do. Being house officers and settling the ward stuff. Therein came 2 incidents which occurred. Incident 1: Showdown with the new Reg AKF and I were there on the ward round and we had settled all the ward work that needed to be done, and had finished by about 1pm. We wanted to go for lunch, and so we told the new Reg on that day that we were going for lunch. Penguin Assessment Unit was slightly busy then, however, 2 of the SHOs were on, plus another 2 Regs for the whole day, so we thought they didn't really need us. We had gone for lunch, and went to the Mess to chill out for a bit, (considering we had finished most jobs, which were actually supposed to be done by the SHOs and Regs.) We were away a total of just beyond 1 hour. When we walked back in, we met the new Reg, and he just asked us 'Where were you?', and just stood there staring at us, waiting. AKF could see I was about to explode (judging from my facial expression), and so he started to give some explanation about why we were long. 2 days later, during the ward round, I had an altercation with that same Reg. we needed to write up some medication for a patient, whose drug chart was more or less full-up ont eh front page (for stat doses), apart from one blank row in the middle. And so I told the nurse that I will write it up after the ward round (as we needed to rewrite the drug chart). He refused to believe me, snatched the drug chart away from me while I was still holding on to it and talking to the nurse, and flipped to the BNF and told me to write up the dose then. I told him that nurses won't give the medication, especially if it is written in the middle, as I had encountered this before in Medicine and Surgery. He refused to believe me, and because I refused to write it down then, he wrote it down himself and gave it to the nurse. 10 mins later, the nurse was back, and asked him to rewrite the drug chart, as they were not supposed to give the medication if it is not written properly (in chronological order). He then gave me the chart to rewrite, and instructed me to write it up then! I was quite pissed off, and while begrudgingly writing up the chart, I mentioned that that was how the system worked there, and it would be good to listen to others on the team (something to that extent). He then turns around and says that we should work as a team (?!?!), and we should listen to each other instead of trying to work against each other. WTH?!? Wasn't that what I was trying to get at all along?? I got really annoyed then, and I knew that I had to walk away before I blew my top, and so I did. Incident 2: We have this F2, who seems to know his stuff, and is quite a smooth talker. He wants to be a surgeon, and had just finished orthopedics. He started the same time as us, however, we've realised that he is actually a lazy bastard. Several times, when AKF and I were on together with him, and he was on-call, he would just disappear immediately after the ward round, and not appear on Penguin at all! He would not even answer his bleep, till he was bleeped several times! On one of the Thursdays, he was the Outpatients SHO and we were swamped in Penguin. Literally. Parents and their kids came in 5-8 at a go. It was just me and the Reg. He didn't turn up even though he was supposed to after Outpatient clinics, and in the afternoon, he supposedly had to go for teaching (which he never did in the first place!), and after teaching he was supposed to come back to the ward till about 8pm (which he came back at 6.30pm, when teaching was supposed to finish at 5pm, and that was only after multiple bleeps! He didn't even have his bleep with him. It was with his gf instead!) And then, he left early at 7.30pm that evening, when his shift was supposed to finish at 8pm. I had left at 10pm that night, and I was supposed to go home by 5pm! I felt bad though, that I had to leave 5 patients to be seen by the night team. By that time, the Reg and I were just dead on our feet. It was just ridiculous. But anyway, that night, I saw lots of interesting cases and did lots more procedures than the Paeds Regs would allow me to do normally. It also fostered better relations with the rest of the team. I've asked for some feedback (while doing all the tedious paperwork of CEXs and CBDs and DOPS), and it's all been good so far. They trust us enough to know that things will be done, ward work will be sorted, patients will be seen and sorted to, and we won't try anything crazy. They trust us enough to manage the kids and do procedures unsupervised. It's a great feeling. =) To know that they trust and respect you enough to manage and handle the kids and the parents on your own. And to know that you'll ask for help when needed. Lots of people who have been on the Paeds rotation before us think that it's just like being a glorified medical student all over again, only this time we are paid. That's absolutely not true. When you show that you're capable, they trust you enough to handle yourself, and that says a lot. :+: Other musings what else have I been up to? Not much really. Been surfing around and trying to sort out accommodation and what to see on my long-awaited vacation to the East Coast of USA at the end of this month. It's a birthday present for the little one from me, for being the annoying but great little sister anyone can hope for. Incidentally JTI will be int eh vicinity during that period of time as well. It will be interesting if we do meet there. A couple of week ago, we had this massive group of PRHOs, SHO, Regs and even Consultants on a bowling outing, one of the weekday nights. It was a fun night out, and great to meet up with everyone again, especially my surgical team. We were 'Will's Kidz', and it was just hilarious! More to come hopefully! Just last week, AKF and I just met up for a night out with the surgical crew from my rotation. Drove all the way down from Kent and had dinner at Crossharbour & London Arena. It was such a lovely evening catching up with my previous SHO Mary. Shirley, one of the surgical registrars was simply funny! What can I say? I have a great bunch here at Medway. =) :+: Okay, have to go zzzz now. Think I've updated enough for this entry. Till later! =) Saturday, April 22, 2006 I haven't been writing in a while. Past 3 weeks. Been trying to settle several things at once. Exams, air tickets, accommodation, getting used to the new wards. Hibernation phase, really. Lots to tell. Just thought I'd pop this here before I forget, and before I go back to studying. Paediatrics - loving it, but... Incident 1: concerning the F2 Incident 2: Concerning the new SG/Reg Bowling enmass... + dinner... Gym and walks... with sg drive Exams.... Planning... Haven't been to London in 2 months, but baby, I'm coming back! Having a car... Missing some.... Okay, gotta go back to studying now. Don't think I'll make it for this exam. =/ Tuesday, April 04, 2006 Gone is Medicine.... Here is Paediatrics Yup. I've officially finished Medicine. And I've started Paediatrics. It's a whole different ballgame altogether. I just did the weekend on MAU. That was my last 2 days on Medicine. And it was just wonderful. That last Friday, instead of teaching, we had handover, and so I handed over some of the ward patients to the next incoming HO. But before that, AT, my buddy HO and my SHO and buddy Reg, we had lunch together, and it was just great! If not full of gossip, then it's just full of laughs of funny patients or experiences we had. Then before I left Nelson (that's the name of my ward) on Friday evening, it was sad walking out of the ward, but not before the nurses and CSWs and I had a good 'ol cup of tea and sat down to just chat and chill, which I've seldom done before with this ward's nurses. However, it was quite an eye-opener to hear them talking about the doctors and commenting on how we were. I had good feedback, and the nurses were really nice, and we exchanged numbers and emails to keep in contact! =) Over the weekend, when I was on MAU, the same thing happened, and some of the nurses and I exchanged numbers too. It was nostalgic, to say the least. All amongst the time where we had ups and downs and trying to cannulate patients, or reviewing ECGs or Mel saving lunches or dinners for me, or me giving 'big maria' a massage, while I'm waiting for my patient to come back from X-rays. Or us just joking around with Raj or Shibu trying to get beds for our admissions or Trop Ts. It's nice to know that we are appreciated, and we can appreciate other staff too, and that all of us can work well together, given a good attitude. It was also a pleasure to know them, coz even though work can be so busy, it makes everything seem rosy. I was also pleased to know that they liked the work I do, and the ward clerk loves my smile! Haha... Next, I also got my mini-pat assessment from Mr W, my supervisor. He and WG, my ex-reg, was in their office at the same time, and after bantering around with them, we got down to serious business, and they were appalled to see that I had quite low self-confidence, in terms of how I assessed myself to be, and WG said that I was a 'silly cow'. Haha.... But both they and I are quite happy in the feedback. (The mini-pat is an assessment that they have in the MMC for all Foundation Programme doctors, where feedback will have to be gathered, not just from their peers, but also the nursing staff, their supervisors, etc.). My feedback, or rather, the gist of it, states that I can 'communicate well with staff, patients and relatives. She is very reliable and when asked to do a job she does it quickly and efficiently. She is well liked by both patients and staff'.... 'Knows her limitations'... 'C has a very friendly approachable manner with both staff and patients. Keen to learn and effectively utilises advice given in the clinical environment'. This boosts my confidence a bit. Sounds like I'm heading in right direction, eh? =) :+: Start of Paeds Today is the 2nd day of Paeds. We're bleep-less now, and I'm kind of missing it. It's a catch-22 really. When I had the bleep, I didn't mind it, as long as it didn't ring. But when I had it and it rang continuously, sometimes I feel like throwing it against the wall and say to it 'stop bleeping me!'. But now that I don't even have a bleep, it's as if something is missing, especially so when I've been busy with it for the past 8 months. Paeds is a whole different ballgame, and takes a little adjusting. As HOs at my hospital are supernumery at present, we still help out, but depends on how proactive you want to be. Considering I can't remember much about Paeds, it was a wonder we actually managed to see patients in the assessment unit, without much trouble. Thank goodness I'm with Asg again, my buddy whom I worked with in Surgery. We make a wicked team, and now, after a short period of 4 months of not working together, the chemistry is still there and we end up finishing one another's work. Haha... It's gonna be quite fun working together again. =P On another note, the kids are so cute!! I've not made anyone cry yet, and it seems I have a knack for them (given how I'm almost the same height as some of them), but the team seems really nice, and I think it will be another wicked experience. =) Perhaps, by the end of this 4 months, I'll be tempted to going back to Paeds and give up on Surgery. What say you? :+: Outcome of Application We've got the results of our jobs last week. I've got a job in London for the following year. It's a year-long rotation, consisting of A+E, general surgery, and trauma + orthopedics. Guess it can be considered a surgical rotation. With something like that delivered on a platter to me, i'm wondering: Is The One above trying to signal/say something to me? Would I be silly to apply back home still? Would they give me as good a rotation if I want to do surgery? What are the chances? Realistically speaking, I'm not as keen to go back yet, coz I'm enjoying being here. But the visa regulations are changing, and I might have to go back sooner than I planned. Can I have a sign please? Or is that already signposted big and square? Monday, March 27, 2006 Long Rant Before I start, let me jsut say that I am back to normal, and have been for the past week. Warning: This is a post about ranting. Think I've been away from London and my friends for too long. I feel the inertia. t's great to be doing nothing, and yet I know that there's things to be done. People have gotten their postings today. At least those from GKT. They know where they are going next year. Those from my uni don't know yet. WE won't know till... some time later this week, I suppose. Suspense is a poor substitute for procrastination. I notice I have been very short-tempered lately. Incident 1: I was on-call in MAU over the weekend (18-19 March). One of my coleagues had swapped with me as he wanted that weekend free to go to Ireland for St Patrick's Day. But anyway, we were continuously busy throughout that whole weekend , non-stop. On Sunday, we were one man short. One of the ward SHOs had called in sick. And we were already 1 MAU SHO short. And so, the MAU SHO (VP) covering MAU took the bleep and covered the wards, MAU and his own bleep. In the morning when I arrived, he had to go on the post-take ward round with the COTE consultant (it's pointless having 2 HOs doing the ward round with the consultant), and so, I stayed in MAU to clerk patients in. So there I stayed, the whole day, till 2pm, without senior cover, until the other MAU SHO turned up, with the locum SHO. So there we were, all the way till 9.30pm. Where VP and I said , enough was enough, and we were going home coz it was the end of our shift, and we were really too tired from the day. And who comes ambling in but the night Reg covering for the regular (MSA-the Associate Staff Grade which is equivalent to a Consultant), and he tells us we can't go till we finish up the 2 patients who were still waiting to be seen. We were flabbergasted. We went "What?!" And then he said that we shouldn't be leaving patients for the night team to see and how they were they supposed to finish seeing them. Firstly, that's what all the shift work is all about. Secondly, they had the whole night to see them, considering we weren't expecting any more people and the people were more than capable of seeing them. Before I degress further, the MAU SHO (RP) who came in at 2pm defended us, saying that we have been working non-stop and MAU was really busy today and we were short-staffed. Even though there were patients waiting to be seen, they will be seen sooner or later that night. And MSA was there telling him to stop whinging and continue doing work and stop slacking. That got me mad. Furiously mad. And so, I told him off. Well, at first, I tried to reason with him, defending the SHO, saying that we were really swamped today, and we were 1-2 man down. Whatever RP was saying was true. MSA proceeded to tell me to mind my business and that RP was just whinging and he should start doing some work. That got me really worked-up. And so I lam-blasted him there and then, in the doctors' room of MAU. " This IS my business. I have been on MAU for the whole weekend, so I know how b usy we are. I know RP, and he is not whinging. It has been manic today, and I haven't been out of MAU today. At all. I haven't had a toilet break, I haven't had lunch or dinner. So don't come in here and that RP is whinging bercause he's not. You don't come in here and tell us that we are not doing our work, because we have and the whole of MAU can testify to that." (faces of the MAU nurses nodding, while my colleagues looked stunned). MSA looked stunned as well, but he suddenly tried to be pally with me and started patting me on the shoulder, and saying that he's just joking. " Don't touch me (while I shrugged my shoulders to relieve of his touch). This is no joking matter. It is serious. Here we are, working our butts off, and there you are implying that we are slacking. What is the meaning of this?!" His reply? "Erm... I'm going to A+E now". And he walks out of the room. On the way though, he headed into the doctors mess instead. WT *beep*? Ironically, I can tolerate lazy people. The Reg who was on-call in the day over that weekend was in the mess sleeping throughout! That I can stand. And MSA has a reputation of being a lazy bastard. That I can tolerate. But to accuse us of not doing work and ordering us to stay to clerk the patients in. That is simply something I cannot stand, and I will not accept. It's fine if you want to be lazy. But to accuse me and my colleagues of being in the same class as you when we are, in fact, not, is beyond me. Other people may accept it, but I don't and I will not. And so, now, we are not on speaking terms. I am going to suffer this weekend, coz he's also covering for this weekend, when I am on MAU. How lovely for me. I most probably won't have a job if I were to apply here ever again. And apparently this has gone around the hospital, somewhat. The HOs at least. My colleague who was there when it happened, said that he will not want to get on the bad side of me in future. Haha. Funny. Not. Other than that, I actually quite like working in MAU. Incident 2: Today, we finally got a CT abdo for one of my patients who is not fit enough to have any colonic imaging at present. And I get called 5 mins before the scan, saying that he, the radiologist, is not prepared to do it because there's a risk that with the Cr of 150 (she previously came in with a Cr of 1000+ and had to be haemofiltrated), there's a possibility of acute renal failure, with the contrast. Unless I am willing to sign a form stating that I will take full respsibility for that happening, he is not going to do the CT. And so, I spent the afternoon running around and trying to contact the renal consultant to ask for some advice. By the time I got back to him, the radiologist had already gone home, and it wasn't even 5 yet! argh... And there I went to explain to the patient why she dodn't have the CT, and understandably she was very frustrated and fed-up of being in the hospital. However, she was angry at me regarding her bloods that morning, and I tried explaining to her that she had misunderstood it, but she was not having any. She just cut me off and didn't listen to any explanation. So I said I'll come back tomorrow. I was tempted to be short and rude to her, especially when I had spent 45 mins expaining things to her, but I didn't. Guess there's some projection of feelings involved. Also I've realised that I am a person who can explain once, aexplain twice, but if you don't get it by the third time, I'll not be very patient anymore and actually just be quite short with you. It's my nature. But it's just not good. =/ Also, through phonecalls, I notice that if people on the other side don't seem to get my explanation, I tend to be more aburpt and my tone of voice actually changes, quite subtle-ly, and not for the better. Hmm... =/ Wednesday, March 15, 2006 A continuation of the sick saga This is truely the one time that I've been as sick as I possibly can be. It started on last Friday, with a high fever (fried a few brain cells there...), chills and cold sweats, and myalgia. Thinking it's just one of those times where I have a high fever once every 1-2 years (and after a long long sleep and good nutritious food, I'll be fine), I just followed that and slept. A lot. Woke up the next morning, coughing out blobs of blood in mucky sputum. Gah! Does that mean I have a pulmonary embolus??? *frantically thinking if I have chest pain.* Thank goodness I don't have, so PE is unlikely. Maybe a nasty bout of pneumonia? *listens to chest* Nope, chest is completely clear. Not even a sound of creps or crackles or wheeze. Breathing is fine, not laboured. Hmm... blood tests? Nope, hate needles. Don't touch me with one. Being otherwise asymptomatic, I just rested over the weekend, with lots of water, sleep, paracetamol, and Clarinase (just in case...). Woke up on Monday for work. No voice. Barely a croak. Otherwise fine. No headache, no myalgia (body/muscle ache). So I thought, hey, today is the consultant ward round, and I can still do work, just not do much talking. So hey, why not goi to work? If I last the whole day, I might even be able to go to the gym later on! So in I went. And I then realised, as doctors, we not only use our non-verbal skills, but do lots of talking too! Even if not with patients, with others, nurses, colleagues, referrals, chasing blood results. And that Monday, everyone wanted to talk to the house officer. I don't know why. So yeah... went home with a drier throat, but lasted the whole day. Hurrah for me. Tuesday. Woke up with at least an on/off voice aka can still emit some sound which sounds remotely like words. Went for the ward round again, but not talking much. Went about my normal work and finished work at about lunchtime. Thank goodness, coz when I went for the X-ray meeting, the CT lady said I needed a doctor instead. Indeed. she was so true. And so, I decided to go back home to rest. Handed my bleep over to my dear buddy, Andrew, who kindly took it over without any qualms (then again, there wasn't much to do, coz i had finished what needed to be done). Went back home and slept. Not improved despite tons of water, cough lozenges, some Beechams cold relief, lots of honeyed water. Nada. Wednesday. Woke up to my alarm clock. Head feels heavy. Really couldn't face the day at work, plus I was on-call today as well. Why torture myself, especially when I'm sick, right? so, for the first time in history (I have never taken sick leave at work or in uni or at jc or sec sch. The only time I went missing from classes was because of competitions!), I took a day of sick leave. Warranted, no less. My colleagues were saying, I should have taken it from Monday. But anyway, today, I tried steam inhalation (didn't do much good, coz my nose became clogged up after lifting my head from the bowl of steamed water, must be because I forgot to put vicks drops in it), finished 2 bottles of honey (not much use for the sore throat, coz it's more painful than ever when I cough), slept the whole day away, strummed the guitar for a quarter of it (and figured out more chords for lavinge's and blunt's songs), had a bit more voice back (but sounding like a stuffed/croaking/housemates-say-husky-or-sexy voice). Guess what? Now I even have subconjunctival haemorrhages! Now I look scary with bloodshot eyes (as if I've just been drinking the night before and gotten hung-over), which won't go wawye till 7-14 days later, and I can't do anything about! Now THAT's gonna scare my patients even more now. Gah! And I'm on-call this weekend! Aha! But I've found something which actually makes my throat feel not-so-dry: Lo Han Guo. I swear by it. Alas, I've used the last of my supply. Let's hope this works tonight, and I will have a proper voice again by tomorrow. *crosses fingers and looks at the bed longingly* Monday, March 13, 2006 I'm a Mandarin!You're an intellectual, and you've worked hard to get where you are now. You're a strong believer in education, and you think many of the world's problems could be solved if people were more informed and more rational. You have no tolerance for sloppy or lazy thinking. It frustrates you when people who are ignorant or dishonest rise to positions of power. You believe that people can make a difference in the world, and you're determined to try. Talent: 44%Take the Talent, Lifer, or Mandarin quiz. |
