jitters

i've been away from adult ortho for so long (did spine, then paeds ortho then hand rotations).
tomorrow i'll be back for the first time in 1 year. wow.

can't remember the last time i scrubbed in on a hemiarthroplasty or a IM nail. frantically reading up on these tonight in the hope that i will be able to cope with OT alone toms... hopefully someone will be free that i can beg to help me out!

also posted to a team where this was a boss who once told me, "i can't see you as a surgeon."
the younger me tried everything to fight this and prove him wrong, but the me-right-now just agrees with him and wants to leave medicine.

but i know i shouldn't leave, i'm sure God has a plan and i need to hang in there.

gonna sleep early and hope that i'll survive tomorrow. praying hard! 

back (to you)

(title from bryan adams' song - you really need to listen to it!!!)

3 years is a long time to be away! but hopefully i'm back and here to stay. i've had so many pent up feelings that just don't give themselves over to instagram or facebook in short pithy captions. and each time i've told myself that i will blog about it... but guess who is the queen of procrastination as usual?

(clearly that was me in case you didn't know haha)

hopefully this blog will help me work through my angst and give me an outlet to express my frustrations and i'll be a less angsty person after (who am i kidding)

so it's 2017 and i'm in my 4th year of residency and 1st year of senior residency (equivalent to SpR) and the burnout that i've blogged about previously is back in full force. Unfortunately taking a break is not really an option at this point due to various circumstances. i guess i'll just have to learn to cope better?

if you have any tips on coping with burnout, i'd be super happy to hear them! :)

2014 hellooooo!

have passed my mrcs (with flying colours, i got 89%, whooopppp!). and also gotten into ortho residency!

finished my mandatory 6 months in General Surgery as part of residency requirements - am so glad it put to paid all my GS dreams that i ever once harboured. really doubt i would have enjoyed it much.

back to A&E! loving the adrenaline rush that resus gives me. tubed a patient at first pass yesterday in a collapse. felt super awesome after that!

but also am very slow. thankfully people are very nice so it's tolerable. not so much pressure to keep up with the case loads as well, phew. the rest of the residents are really nice and friendly too so it's easy to find friends :) also B and patty are there so it's quite good :) 

i remember being lost on my first shift and B had to rescue me and tell me to go home since it was so late already. also patty taking over my cases and shooing me off a few shifts later. friends are really awesome to have!

so what did 2013 bring for me?

well, had a major burnout and seriously considered taking no-pay leave but was told in no uncertain terms that it was disapproved of by my consultant. :( found myself dragging myself to work everyday with no joy in life. i suppose it was made worse by the fact that i was a single resident in a busy team and no intern to help me. not to mention i don't drive so the commute is a nightmare.

went to philippines twice on disaster relief missions. first in october for the earthquake in bohol, 2nd for the super typhoon haiyan mission in ormoc. eye opening and now i'm not so scared of missions work anymore. made some great friends and learnt alot about hardiness and resilience in the process. filipinos are amazing. 

will always cherish the lessons i learnt from them. 

we had leaking ceilings, no hot water, no electricity, horrible food, even experienced aftershocks. but i'm glad i went. i don't know if i made a difference, but i really sincerely hope that i did.

travelled to new zealand after that, and i got to check bungy jumping and sky diving off my bucket list! :D no regrets there, it was really awesome! sky diving is so good, i need to go a few more times! 

alrighty. wondering what new adventures this year will bring me on. excited! here's hoping we all never let adventures pass us by <3 div="" nbsp="">

exams in 12 days. OFFICIALLY PANICKING.

you know the feeling you get when you really can't study any more and yet you feel like you don't know anything?
that's me right now.

made worse by the fact that all my boys got pushed to an earlier exam on 6 and 7 october in coventry and i'm in edinburgh. so i have no more study partners :(((

was super thankful to receive a call from W at the airport when he was boarding the plane to london, in his usual fashion of, "ZOMG stop feeling sorry for your pathetic self and go study or sleep. don't sit there and mope now that i'm not there to kick your arse. and eh send me Ranson's score. Glasgow also. And wish me luck for pwning the exam!"
oh LOL what would i do without the boys. very thankful for 8 years of friendship and counting. we have seen each other through 5 years of exams, numerous on-calls, relationships and deaths.

Always regretted not deciding on ortho earlier (instead of wasting time on ob/gyn!), but that would have meant taking exams without the boys (lost 2 years going back to army for conscription).
tradeoffs for everything :)

so went for yoga today. very good for me - breath of fresh air after being cooped up at home/office for a week! flexibility is the pits now :(

gonna take a nap and do questions with W later over whatsapp (technology, i love you!). he has gotten to london safe and is going for breakfast at harrods (i hate him). S, L and P have reached coventry safely and C is flying now. fingers crossed!

flying in a week. PANICKING!!!!!

omg i have abandoned this blog for a year! :( i am sorry!

it's just so much easier to type short things on twitter, no need to sit down and ruminate and pen out a proper blog entry (not that i actually sit down and ponder what goes into my blog entries, but still)

if you follow me on twitter, you will know that i didn't make it into residency. again. and yes, i was horrendously disappointed and upset and angry etc etc. but i've moved on and gotten over it. hopefully next year! (and i think next year is the last year i will try for ortho)

still loving ortho! had the best reg ever in Spine which made the 3/12 there quite fun actually. he's like my big brother. best part was he actually let me do a cancellous screws on call with him! :D and you know what, the check Xray was fab. so i rock okay :D (rather, he rocks hahaha)

i also passed mrcs part a! which means that come october, i will be flying to edinburgh to sit for part b! looking forward to returning to UK once more :D :D :D
sunday roasts, primark, marks and sparks, sains, and so much more :D
and hopefully i pass my exam ;)

if i should be following you on twitter etc drop me a line! you can always find me @ditzydoctor

gonna keep this blog alive somehow. can't give it up just yet! :)

un-matched

residency results came out and i didn't match. rather upset about it, all my friends matched happily (except the boys going into army, different story). i hadn't harboured much hope, esp since they kept saying the pool is very small, very few will match in. but how come all my friends matched and i didn't? really thankful for my non-med friends who are bringing me out for drinks and wallowing in misery toms. could really do without more of this rubbing in your face thing right now. am not as depressed as i thought i would be (since i was actually considering rejecting residency and applying for emed training instead), but it really kind of sucks to be told that i am too lousy to be matched. many people have told me i am quite good, so WHY?? WHY. sometimes we don't understand how things work. i don't. i don't understand all this, am not going to pretend i do. but as long as i have chocolate and family and God, things will be okay. just give me some time

today was a much better day :))
i did walkers today, ortho cases make me :))))
plus even managed to diagnose an anterior MI and get a "well done" out of the grumpy cardio registrar which made me really :D :D :D :D
somedays, i really love my job! today is just one of those days :)

oof

so. today was not the best of days. i flubbed 7 out of my 8 plugs that i had to set. i saw only 8 patients.

i could have pushed myself, stayed overtime and seen a 9th. but what would have been the point?

somedays are good days and some are bad days. today was a bad day. i felt like a noob intern struggling with plugs again for the first time, like my first ever call in the labour ward where i failed 8 plugs out of 10. that was one miserable night! :(

but like all things, it comes to pass. today was made much better by eating my hand delivered aussie tim tams (thank you so much chris! :) xx), drinking green tea, and watching Yes Minister :)

i will never get tired of humphrey's ridiculousness :))) and i love their language, it is really all sorts of awesome! must go re-read the books ;)

i could really use a break. and i just had a break! :\ uh ohhh. but super looking forward to gold coast, i must say :))))

dissections

dissecting aortas, that is!

wasn't personally involved in caring for the patient - but my friend was. turns out the intial complaint was of upper back pain, not resolving despite iv morphine. On his very good suspicion - CT aortogram was done, which showed...

A STANFORD A DISSECTION.

WHAT THE BLOODY HECK! how rare are these compared to msk strains and the like!!!! omg. @_@

so vascular came down to see patient - arrangements made for him to be transferred to a level 1 cardiothoracic surgery centre were in place, and ambulance was right outside waiting, when...

THE PATIENT COLLAPSED.

again, WHAT THE BLOODY HECK! he went into VF and was shocked. at some point, the vascular attending was there along with the vascular and CTS senior residents (having driven madly down from the level 1 centre). omg.

decision for emergency thoracotomy was made, and internal cardiac massage done. it was so abso-bloody-lutely thrilling to watch the heart being massaged and shocked with internal paddles, a feeling i cannot quite describe except that my heart was in my throat, hammering away, and felt like it was about to jump out at any minute.
there was SO MUCH BLOOD evacuated from the pericardial cavity. that must have been some dissection (and it was, when i saw the CT scan!).

it was all very well and thrilling, until they decided to call off the resus. the patient's daughter is from the same college as me, and i felt so super sad when she turned up in her logo shift and college badge :( :( :(
i mean, things always hit closer to home when you can relate somehow, eh?

am totally grateful that i managed to witness all that (hiding behind curtains, perched on a stool, hidden by the human wall of nurses). it was really quite amazing, not to put too fine a point on it. well worth my staying back over an hour to see what happened!

emed simultaneously repulses and thrills me. i detest drunks/regulars, but i absolutely LOVE the thrills of a resus! seriously considering emed, but i'm not quite sure if i can actually give up ob/gyn or the OT!

things that make me happy: starbucks peppermint mocha in the largest kick arse size :) :) :) love the cheery festive packaging too! :D

Emed

1 month into emed and i quite like it! :D

really regretting my decision not to put emed as one of my residency choices - but it was a toss up between ortho and ob/gyn anyway!

being the closet adrenaline junkie that i am, i LURVEEEE resus shifts! :D low BP, unresponsive patients, collapses, RTAs/multi-traumas, STEMIs - WHOO HOOO bring them on! :D :D :D
(alright maybe not so closet)

learning many procedures, still can't tube very well. chest tubes are lots of fun, T&S is alright, loveeee M&Rs! (i think i sound crazed here, sorry!)

still not entirely used to shift work, suffering from bad gastritis. losec is my saviour, i must say! really must learn to eat properly on shift, no one is going to thank me for giving up meals/toilet break in the long run anyway.

thankful for nice senior doctors and friends around :D

breather

yessss it's the long weekend! :D

just what i needed - started it all with a great call on thursday night - unbelievably good! :D
well, except for 2 things:
1) my attending REFUSED to let me do an evacuation - i was most upset!!!! no reason for refusing, it was a straightforward simple case!
2) my delivery wasn't the best, perineal tears up to the urethra and clitoris, OMG. thankfully the episiotomy repair wasn't epic, took me only 30 min. still, i hope she has no problems peeing!!!
cute baby though :D <3

enjoying myself muchly this weekend, going to have a rest and sleep till i have functional decline, hurhurrr!

oncology

... gynae-oncology, to be precise.

the patients are such sickies, and i fear that most of them won't make it.
it saddens me immensely when we prep the patient for op, hope for the best, and when we open up - tadah! tumour everywhere.

it just feels like such a waste, the intensive pre-op tests, the hopes and expectations, and i don't know, the feeling of being beaten before you've begun?

but thankfully, my bosses have much more experience than i do, and prof (being the awesome prof that he is!), will "roll up his sleeves and plunge elbow deep into the muck".
if i'm EVER having any gynae op, i'm definitely getting prof to be my surgeon!!!! sheer awesomeness!!!!

EBL for a certain Wertheim's was 6L - more than the blood volume of the patient! yet patient is still alive and kicking (not very well, but you get the idea). chances for this patient look good :D i am so amazed.

i used to wonder, who would ever want to do onco? but now, looking at my rotation through (obviously you need a heart of gold, think it's possible for me to grow one?) gynae-onco, i think it's a very worthwhile and fulfilling career path - i just don't know if i like it enough to want to reach elbow deep into the muck everyday! :\

caesars

i was happily sitting in my clinic on friday, shaking my legs, dreaming of watching world cup later that night (hey, i'm entitled to! the patient load on friday is light as all trainee residents have to go for centralised teaching, leaving us non-trainee residents behind to do the proper work. bah), when i suddenly received a call from The Boss himself (head of dept!).

The Boss: (booming down the phone)"DITZY! come up to OT and assist me with the CS."
me: "oh ok yes sir sure sir anything you want sir" (grovelling in shock)
The Boss: "STAT!!!" (proceeds to hang up phone with a click)

so i hang up my phone, grab my bag, tell my clinic assistant, and sprint out of clinics and into the OT changing room (i change in under 3 minutes, what an achievement!) in under 5 minutes (and am totally breatheless by time i arrive in the OT).

spying The Boss already prepping the patient (and thinking "OH MY GOODNESS that should be MY job"), i open my mouth and squeak "sorry boss! will scrub now" breathlessly. so uncool. :\
however, The Boss threw me a ?grateful look - to which i was clueless as to why at that point in time.

opening the scrub door, who do i see but the "Hopeless Intern" (names have to be kept hush hush on this blog!) happily taking his time to scrub up. :\ now the reason for the grateful look becomes clear!
the circulating nurse hurries to open my gown and gloves and quickly bundles me into them, all scrubbed up. i even manage to put my hands on the patient before Hopeless Intern! geez.

surgery was adhesions +++ arghhh. unable to see bladder, unable to see uterus. everything was just stuck together in one big mess. i couldn't figure out where to put the doyen's, i had no clue where the ligaments were - really need to spend more time in OT!
Hopeless intern was really hopeless. despite The Boss' and my instructions, he just couldn't do anything right. i don't know if it was his first time in theatre and he was freaked out by all the blood and gore in sight, or if he was just sleeping on his feet cos he was tired, or if he was just hopeless.
but despite instructions like "my dear, the DIATHERMY please" or "ARTERY please" or "please DAB, not swipe", he just couldn't get it. The Boss was highly frustrated, and had me doing most of the assisting for the op. thankfully he's pretty nice and i've assisted in a few caesars before so yelling was kept to a minimum.

i ended the caesar with liquor in my crocs and blood dripping down my pants and splashed liberally across my crocs. ewwww. but mum and baby are doing fine so i've no complaints :) :) :)

CAESARS = LOVE :D :D :D

i love caesars!!!!! a happy outcome is always good, esp when you get something like NRFS. scary! thankfully baby cried a short while after, neonates proudly dangled him up at us whilst we all smiled in relief :D :D :D

i'm learning to take the ridiculousities that A&E sends in stride, no point getting angsty and emo over crap cases like "constipation colic. please review for ovarian mass" (hello, how are the 2 even related???).

another tough week at work awaits, 1 month of clinics, dear God, please help me :\

resident

oh my goodness, this being a resident malarkey is far harder than i thought it would be!!!
the amount of stress and responsibility you have is far, far more than an intern does. plus you are expected to do so many more things like RUN CLINICS.

let me explain about RUNNING CLINICS. it is like the game L4D2 (in other words, left for dead 2. and yes, i was given this term by my computer games playing guy friends haha. i claim no knowledge of it whatsoever!).
you sprint to clinics after your morning rounds (which are usually draggy because the attending comes late, so irritating), and to your shock and horror, there's already 7 patients lined up and waiting. ARGHHHH.
and because this is OG, you need to sit down and explain everything clearly and carefully to all the patients (not that other specialties don't do such a thing, but the malpractice costs are much higher in OG!). and then you need to be empathetic and sincere to everyone, and your patients can take their own sweet time to undress and get on the examining couch so you can PAP them, following which they need to get dressed S-L-O-W-L-Y and you need to explain your examination findings.
a fast patient is one that takes under 10 minutes, but most will go over the time limit. and you need to end morning clinics, eat lunch, review ward patients, trace results from morning clinics, and then sprint to afternoon clnics again. whew. what a marathon!!!!!

(by the way, the above was written partly in sacarsm). as you can see, i detest clinics!

exams

resits on monday, stressed +++

hope the studying i've been doing will pay off!

on another note, absolutely sad to leave my current team. it's a dream working with my fellow intern and my resident, love them boys to bits. work gets done, patients get discharged, everything is taken care off and we still get long lunches with long gossip session :D :D
this month has been heaven in comparison to last month's suffering! :D which has been exactly what i needed after 1 month of being NBM and NPU through the days.

doubt i will have another team as nice as this, but it's gone a long way towards increasing my affection towards general medicine. haha!

wish me luck and prayers please everyone! :D

2.5 months to go

the end of my intern year is in sight!

only 2.5 months to go, the thought is making me joyous and yet terrified at the same time. i will be fully registered in 2.5 months! no longer can i hide behind the P letter anymore. i will not be able to ask my resident anything and everything on the pretext that i am only a dumb intern. i will be the resident. OH HORRORS.

but that will also mean that i have less stupid things to do. hehe. hopefully that means more free time! :D

my current ward is like heaven, after last month's ward and team. this team is super nice, everyone is patient and kind. plus my fellow intern and my immediate boss (junior resident) are really lovely guys and i adore them to bits to taking great care of me! they shoo me off post call by noon, they help out with sticky situations, and we really click very well :)

the saddest thing so far has been having a code blue activated on a palliative care patient.
it all happened so fast! my first ever code blue. passed by in a complete blur. we didnt' even have time to check the files, just asked the nurses who all agreed patient was for active resus. bagged the patient, tubed, set femoral lines, shocked the patient, and then sent him to icu only to find out that he was for palliative care. OH MY GOODNESS what have we done.
was most terribly upset after realising that.

but i guess, in every resus, you resus until proven DNR. it is a delicate situation, but a decision must be made.

i can only hope he passed away in peace

thumbs down

2 thumbs down!

i have just survived my first medical call - all thanks to my lovely resident!
if not for him i would have collapsed myself, completely clueless and lost as to what was happening.

after 8 months in OB/GYN and ortho, my brain has really rotted away. can barely remember how to do a physical examination (feeling womb size and lie of baby comes easily though!), can barely remember things like dysdiadochokinesis, can't remember how to clerk patients, etc.

felt so wholely inadequate, management plans for patient are very basic are really quite stupid, (but i am sure i will improve with time!) i take ages to do anything, i am so very slow. goodness.
thankfully my resident was such a nice guy, who agreed to see the new admissions with me, who patiently explained, who encouraged me, who went down to buy me a drink whilst i did the passive ward work, who reviewed my patients without me asking, who clerked new admissions for me when he realised i was so swamped, and who never made me feel stupid or dumb.
BEST RESIDENT EVER!!!!! love him to bits. his writing is incredibly neat and nice too, like printing. whoa. couldn't have asked for a better resident on call with me :) :) :) super duper mega thankful. :D :D :D

wasn't too bad a night call by medical standards, 14 new admissions, i clerked 8, my resident clerked 5 without me, my senior resident clerked 1 (omg, yes, i am in disbelief at her utter niceness). plenty of passive things like blood cultures, set plugs, take cardiac enzymes, review results etc. but no matter! no collapses on call, only 1 quite sick patient who remained stable throughout the night. SUPER THANKFUL.

med is a whole new thing from ortho! history actually makes a big difference, examination actually may reveal something you didn't know. treatment plans are of utmost importance. you need to think hard about what blood tests to order, not just the usual PFO orders you write in ortho.

i'm learning some things in medicine, but it's hard to learn when your workload is overwhelming. very thankful that the residents are understanding and do try to help a bit, but after 2 postings where i'm expected to do everything by myself, i really don't expect their help so any help at all is a bonus. in ortho, lunch used to be at 12 or 1 pm, now lunch (if at all!) is at 3 to 4 pm, just a quick bite before exits and then a mad rush to finish things before going home around 7 pm. if i'm on call, it's even worse!

no sleep at all on calls, sigh. but at least i got to leave post-call at 3 pm, got home and crashed promptly from 5 pm all the way till the next morning, exhausted!

4 more months of this. eeks!

happy new year everyone!

this new year, i'll be moving on from one posting to another - from orthopaedics to general medicine (GM).

suffice to say it strikes terror into my heart! in ortho, i have practising "voodoo medicine" and the patient's medical management is left almost entirely up to ME. and when in doubt, refer!

furthermore, this will be my last posting (provided i don't fail!) as an intern and hence, i'm expected to know more than a fresh intern out of medical school. i have completed 2/3 of my intern year!

the scary thing about doing OB/GYN and ortho first is that your patients are generally well patients. collapses are few and far between. sick patients are usually sent to HD or ICU for anaesthetists to manage. but in GM, sick patients are everywhere!
my friends in medicine have told me to expect a minimum of 1 collapse/resus/code blue a night. OH DEAR ME! i have never run a resus before. i can only hope my resident will be by my side or else it will be terrible.

i have no idea how to manage hyperkalaemia/DKA/AMI/fluid overload/etc etc by myself!!! i mean, i know the theory of it all but i have no idea how to do it practically. how much iv insulin do i give in DKA????? it all boggles me!

thankfully my next hospital is a small garden hospital which is supposed to be one of the best places to do internship in as the patient load is lighter and the profs are really pro-teaching and very forgiving. i hope it's reputation holds! :)

i am extremely sad to leave ortho - the orthopods have become friends and they are really some of the nicest/most easygoing/funniest people i know. (let's not talk about medical management here haha) at our farewell, the attendings came up to us one by one to wish us good luck for the future postings and expressed thanks for us working in their department. i was pretty touched! more than one attending has told me to come back to work them in the future as a resident (i'm the only one out of the outgoing interns with a surgical slant), and a few have said they can possibly see me in ortho.
i find that all very nice but i'm rather dubious about my own skills in ortho! then again, after doing step up calls i suppose word has gotten out.
i will really miss 2 of the senior residents though - they were more like friends to me rather than bosses. i remember texting one of them after my first ever mortality in despair, and he called me up instantly after to ask how i was, and patiently listened whilst i sobbed my head off over the phone. i was incredibly touched!

the thing i will miss the most about ortho is the nurses and my fellow interns.
finding such a great bunch of nurses elsewhere is near impossible, and these nurses are really good! they will call families/surgeons/pacify patients/set plugs/take bloods etc for you, and they buy me food and drinks on call too. much love!!!! being on call in my favourite ward is like being surrounded by a huge extended family, they even cook me dinner! :)

as for my fellow interns, i will greatly miss our bitching sessions and much laughter and hilarious stories. it was amazing working with you guys and i think having people whom you get along well with is such a boon! :)

a new year brings new hope, but this year i'm cutting the new year resolutions, pretty pointless for me to do them because i never follow them anyway hahaha.

may the new year bring you new dreams/hopes, and may you all never be short of kindness, goodness and love :)