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 :)

MERRY CHRISTMAS EVERYONE!!! :D

sleep, or lack thereof

night calls are every intern's nightmare.

(a call is when you work the day from 7 am to 5 pm, start call at 5 pm, work through the night till 8 am next morning when call ends, then carry on with day work till 5 pm again. if you're lucky you get a post-call and get to leave around 12 plus at noon)

6 months into my intern year, i must admit that i'm more used to calls now, but that doesn't mean i like them any more.

of course, there are exceptions to any rule, and i have to say that i really really loved labour ward calls, esp when there are caesars aplenty!!!! :D nothing i love better than going in for a caesar :D :D :D time seems to fly when i'm in the OG OT

i used to think A&E calls for ortho weren't too bad - until monday night.
when my resident called me in a panic 15 min before my call was officially supposed to start, i knew things were bad. what i didn't realised was HOW bad.

when i hauled my arse down to the A&E, there was an entire STACK of cases waiting to be seen in the ortho room. oh dear!!!! (the usual is about 3 to 4 cases, maximum!)
and there were 3 patients waiting to be admitted - means i had to clerk them in the A&E or run back to the ward to admit them - and the ward is very very far away!

the worst was doing a blood culture in the A&E - no sterile gloves, no culture set. just swab the area 10 times with alcohol swabs and do a no-touch technique and pray like anything that it won't be contaminated. EEKS!

thank goodness for my very enthusiastic students, who's energy gave aging me a boost through the night. they were chirpy and perky and well, everything i was not. hahaha. they even kindly bought me a drink! :D yeyy!
but really, seeing their energy gave me a boost. i remember how enthusiastic i was back then. every plug to set, every blood to draw, every backslab to prepare, was like a diamond. i craved the clinical aspect of medicine like bees to pollen (not honey hahaha!).
getting to play doctor as a student was the BEST THING EVER! hehe.
now, sadly, i am getting old and jaded. every new case that comes in, i just try to clerk it as passably as possible, every plug i set, just needs to work, every blood i draw just needs to be enough. the less work, the better!
so really, i do owe alot to my students - their enthusiasm helped me pass the night! :D finally packed them off to sleep at 515 am. goodness!

my poor resident and i didn't have time for dinner, we worked non-stop from 5 pm to 530 am. when we both finally sat down at 530 am, i fell asleep whilst she called my senior resident for some advice regarding the admissions. oh dear.
must have looked an awful sight sleeping in the ED! :\
too nauseated to eat breakfast and lunch the next day, left hospital at 2 pm and crashed at home promptly.

but call is over! next one on sunday- ward call. EURGHHHHHHHH!!!!

failed

exam results are out, and i am not amongst the list of those who passed.
but i'm alright, i know i didn't study as hard as i should have, and this result is entirely my own doing. i will make sure i study a lot harder the next time round! :)

survived my passive calls so far, v happy :D
passives are awful calls. you get a million calls for post-op reviews, you take endless bloods, you see all the patients that cannot sleep/itchy toes/cannot pee/cannot BO/bleeding/chest pain/SOB/dizziness/nausea/pain pain pain/ etccc.
ARGHHHHHHH.
medicine is not my strong suit, clearly!
diagnosed a patient with nosocomial pneumonia my last call, but didn't start tazocin as nurses had just given augmentin 1 hour ago. wrote in casenotes to start tazo cm, and passed over to the ward HO next morning, but the attending refused to do anything for patient as patient appears well. OH DEARIE ME :( :( :(
i can only hope that the patient pulls through! :\ will go back and have a look at him another day.

dealt with a VVVVIP patient (some foreign politician's relative, prof's personal private patient), that my resident was ordered to clerk personally and take bloods from. hahaha.
thankfully she was very nice :)
the funniest thing was when my resident tourniqued her hand, stared at it in horror and told me: "i haven't taken blood in a damn long time", right in front of the patient! OH DEARIE ME.
thankfully patient does not understand english. HAHAHAHA!
luckily i set her plug, so all was well and good :D

my lovely senior resident overheard me whining to another intern about how crappy life in ortho is, and said:" still complaining??" hahahaha oops!

more rants about private and subsidised care later on!

world of traction

1 month into my job, and i still haven't learnt to set up traction yet. HAHA.
thankfully my nurses are so fabulous and will set it up without asking me to help - it must be pretty clear that i am clueless!

seems that most people in ortho are nice! :) albeit totally clueless on how to manage patients other than surgically. hmmm. i have given up trying to stop the avalanche of referrals we write on a daily basis asking other disciplines to "please come and see the patient", now i just write them jadedly without asking if they are really needed. :\
each day, i can send about 5 referral letters! oh dear :(

but i must say, those who review my patients are so SUPER NICE and patient with me. they have hardly scolded me, and they are so kindly and i feel so inspired after talking to some of them :)

my greatest thrill thus far was having a pregnant trauma patient! :) i was utterly comfortable managing her. whee! :) but no, i don't wish for more pregnant women to come to me. hehe

renal patients are my greatest nightmare. they have oedematous hands, horrible veins, and AVFs that malfunction so easily. :( :( :( they are usually broke from years of dialysis, grumpy from being poked so many times, and are so immunocompromised and so unwell that they make surgery a nightmare. which equates to - my nightmare because the surgeons will leave that to me. :\ OH DEARIE ME :( :( :(

but that's not to say that the orthopods are horrid people! they are VERY good at what they do. my lovely resident even bought me dinner on call and another let me go up to sleep, saying he could handle all the work. OHHHH LOVE :)

seems like one of the senior residents in another hospital is looking for that special someone! i heard he announced to the whole OT in the middle of an op "I AM SINGLE AND AVAILABLE" very loudly, and when nobody said anything, he went on to say "WHY NO TAKERS!!!!"
HAHAHAHAHAHAHA!
and in that same hospital - a bunch of orthopods also call themselves: the backslab boys!
oh my goodness oh my goodness hahahaha!

alright alright enough of this nonsense. haha!

of bones and rods

in a fit of fatigue, crossness and irritation (that is wholly induced by my new rotation and my current workmate), i told my senior residen, "I HATE ORTHO!!!!" before i could stop myself.
OOPS. that was a real "open mouth insert foot" moment.

thankfully i recovered enough to remove my big fat foot and apologise profusely, but he'd already burst into amused laughter by then. SO SUPER NICE :D

i'm grateful he's going to be my resident on call when i slog through my first ortho call (HORRORS)! can't ask for a nicer person :D

the world of bones and rods is a world i am wholly unaccustomed too, and i find myself missing the world of women and babies terribly insanely much so. i miss caesars, i miss epi repairs, i miss VEs, i miss CTGs (so much easier to read than ECGs!), i miss ultrasound pelvis, i miss alot of things. i miss the nurses, the residents, the administrative things. and the PLUGS, ohhhhh, THE PLUGS!!!!

but that's not to say ortho is entirely hateful. the nurses here are fabulous (mostly!) and really do try. the workload can be very light and i get to eat lunch!
days are early but i don't have to do 630 am rounds :)

on the bad side? i am this toilet bowl, as all interns are - we suck up all the shit that is flushed down, and there can really be alot alot of shit.
i need to remind myself that orthopods are VERY GOOD at what they do. and not at anything else, unfortunately! :\

getting scolded by other departments is a daily affair - seems like everyone is too scared to scold the attendings so they end up scolding you instead. ah well.

presenting at trauma rounds cm, trying to grow a thicker skin because i'm sure to get scolded so bad. hopefully i emerge tear free! :D

exams!

here we go again! new start, new exam toms. freaking out. the questions are so hard, i had no time to study for this, and i'm sure to fail. oh well.

have left OB/GYN for new rotation to ortho, am having OB/GYN withdrawal symptoms so bad :(