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 :)

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!