filling the air

i realized fresh bloody images were a test for me when

we were shown pictures of a brain tumour removal surgery this morning. i cringed at 1st at the sight of the crimson red bloody face, could still take it, and as the day passed, it was forgotten.

later on this evening, i spent 1.5 hours observing a wound dressing being done for a patient with a severe pressure sore at the sacral area.

it was a super huge wound of 10cm x 10 cm x 4 cm. with 4 more smaller wounds beside it, some of which connects to the huge wound in the centre via a tunnel.

as i walked back from the wards to my room, i could still smell and see the image of the wound in front of me. the image isnt so bad. it's the putrid smell that filled the air the moment the wound was exposed. (wore a mask but it didnt help)

at that very moment, my mind was filled with amazement, wonder and awe for all eternity for all nurses in this country, who spend their days in wards through all stench, blood, pus, ammonia etc. to tend to the needs of esp frail patients.

i will never ever in future question the intensity of the job of a nurse, and the passion she/he has for patients! not that i have ever been questioning it before this. lol.

n i brace myself for tougher moments in houseman years as i watched a brannula being inserted relentlessly into the femoral artery of a patient with more than 10 tries and still not succeeding, n few more attempts to draw blood from that area which also failed. (the patient is paralyzed from the umbilical level thankfully, thus not feeling any pain)

wow.

GIT

i need more

Indigestion, colicky thoughts, constipated ideas, altered actions that differ from the heart.

there is no way, no way at all (in my opinion lar i think i could be simply exaggerating) any medical student can excel without

-the guts to ask what they think are stupid questions

-the guts to overcome inferiority complex

-the guts to appear dumb

-the guts to persist even though u noe u're gonna face rejection

-the guts to call doctors even though u anticipate being yelled at or getting a reli annoyed answer

-the guts to try out new things even though it means being ridiculed when making mistakes and looking reli bad in front of patients

becz everyone starts out from somewhere. n we need an essense of humility to overcome that pride in us that doesnt want to face embarrassment or humiliation or unpleasantness.

i need an extra dose of guts. i'm not there yet. i stil hesitate when i contemplate the chances of looking bad in front of others. but then again. its a personal feeling of insecurity. come to think of it, no one is going to rmb your mistake or your face for that matter. patients come in n out of wards all the time. they're like hundreds of students n nurses dun bother rmbering ur names or how u look like. its a place whr ppl are stil forgiving when u make mistakes n ask dumb questions. n yeah. thr's an advantage of being a student who is still learning.

'it may be my fault but pls forgive me bcz i'm still learning *kesian look*' n u kinda get away w it. if not for that day, the next day is a brand new day.

hrm yeah. i guess.

How far can your guts take you?

How far u want ur guts to take you.

*rats what am i doing here??? i'm suppose to be studying!! *groans

taste of clinical year

it took just 3 hours for me to stumble over my block of will power.

i realised i cant study continuously for 1 whole day.

hmmm... shouldnt i have known that by now? like by at least 5 years ago??

what a naive idealist. -_-

a little drop of ink on how i fared the 1st week of clinical year.

thr is certainly no doubt, No doubt at all that clinical year is 100x more interesting than preclinical years. real life situations at last!

however, u get swamped with the ugliness of reality. interesting, but a little tough.

problems i am currently facing:

1. i have not finished reading the basics of surgery related diseases, so am perpetually blur when a patient tells me she has err.. lets say an enlarged thyroid. questions that pop up in my head were: main symptoms of thyroid disease, differential diagnosis for that chief complaint, questions to ask to exclude the differentials and come up w a provisional. then, physical examination to confirm the provisional. then what investigations to be done to further confirm and what management should be done.

n then b4 i finish reading up on how to answer all the questions above, the next day i clerk another patient, and its a totally different scope of disease, say.. hernia. n i go back n put hernia on my list of 'things to be read' and still stuck reading on thyroid bcz i was too tired the last night n fell asleep instead of studying.

so the aim now is to faster finish studying all those stuffs! easier said than done. argh. takes me hours n hours to finish 1 topic. n thr're at least 15 topics to cover.

2. if the supervisor says we should focus on a certain topic this week, so its another different topic to cover altogether.

3. n if i'm scheduled to enter clinic for say.. hepatobiliary that week, then its different again. (diff type of clinics everyday)

i tink the baseline for now is to finish studying the basics as soon as possible.

n finding out how to stay awake at nights to study instead of perpetually collapsing/fainting on my book at my study table. hehz.

ok gotta hit the books!

*on top of everything is finding out how to be nice to patients so that they let u interview them even tho u might be like the 5th person who has interviewed him for that day. n for them to let u examine them even tho u're like the 10th person to ask.

poor patients. imagine staying in the wards for 2 weeks.

1 day = minimum 5 interviews/examination by medical students.

multiply this with 14 days.

the patient would have repeated his history of illness and was examined at least 70 times by the time he gets discharged from the hospital. hehe. got 2 really thank them. some patients are reli nice. some pretend to be asleep when they see u walking twds them from far. i dun blame them. heh.

Sleeping at my own risk

1st shout out on the start of my clinical yr:

i need tips on

How to not fall asleep while studying at night.

Feed me with tips on how to stay awake ppl!! thank you!

emotions, communication, where they come together.

i came across this template n voila! decided it was nice n used it. :)

just back from ppd camp in neg sembilan at a btn camp area. the food was spicy aggravating my sorethroat, but much better than ppd camp 1 in 1st year. other than that, everything else was good.

i learnt thr's more to medical ethics than 1 side of the story.

i learnt thr isnt a clear cut yes no solution in being ethical.

i learnt to humble myself, even at times when i feel i'm not wrong.

and the importance of give and take bcz no one is perfect. i am not perfect. we gotta give space to ppl to make mistakes and look forward from thr.

its about getting through and around the system, while earning respect and respecting others.

I say this, because i am touched that a person forgave me for a huge mistake. to me it was a huge huge blunder. but there was no 'HARRR HOW can you do thisss??' or 'Crap.. now i have to do this / that bcz of ur mistake' or 'WHy din u realise earlier??' and not even an 'OH Noooooo....'.

just a simple reply of 'Its ok. no problem. dun worry bout it. it can be settled.'

This reply not only reassures me and takes away my guilt, but makes me feel a lot better knowing i hav not angered / troubled sum1 else bcz of my mistake.

i truly respect this person, and it was a solemn reminder to me to practise this sort of courtesy to others as well in future.

speaking of medical ethics, a few scenarios in the grp discussion session in the ppd camp spurred me to think further and look at both sides of things b4 making accusations or forming my opinion on 1 side.

When a doctor is charged or accused for negligence, ie. not attending to the patient properly/timely, patient getting contradicting explanations about the cause of a complication that arose in the ward, we need to consider both sides of the story. from the medical staff or system point of view, as well as that of the patient.

there are loopholes in the healthcare system. bcz no system is perfect, and in reality Msian gov hospitals still lack staff. the unfortunate thing is when the loophole compromises a patient's life, resulting in unneccessary deaths at times. its sad. but it happens. doctors missing out on significant vital signs of a post op patient such as severe hypotension, an alarm indicating a flaw (such as inserting a branula into an artery instead of a vein) that goes unnoticed, the exhausted houseman making a mistake in administering medicine in the middle of the night etc.

while the system constantly being improved in order to reduce mistakes by doctors or patch up loopholes in the system, the danger of being that victim plunging into that dark abyss is stil present. in certain countries, pharmacists accompany doctors in ward rounds to reduce mistakes done in the administration of drugs. it brings up the issue of credibility of doctors being questioned (which could injure some pride), conflict of interest, burden on healthcare system. but it's been proven to be successful.

another issue is about communication. its probably something that's still lacking in our healthcare system. patients feel uncared for bcz the doctor doesnt explain to him/her about his/her condition and management. the patient has actually been managed, but bcz he/she was not informed by medical staff about it and given adequate explanation, therefore they feel like they're neglected. communication is important. it prevents lawsuits. according to my Dr. facilitator. true. its a patient's right to noe what's happening to their body and what u're doing to their body.

another area is language barrier. they're lots of cases in gov hosps esp whr the patient has no idea what illness he has been diagnosed with and what or why he is taking this drug bcz the Chinese elderly cannot speak Malay or English and the doctor is unable to converse in Mandarin or Cantonese. i therefore, have to BUck up to improve my Mandarin. like seriously... ! gosh.

in the end its about every member of the healthcare team working TOgether to ensure the well being of patients.

i believe no doctor wants a patient to suffer. no normal person for that matter, wants anyone to suffer. but for now everyone has just got to play their part in trying their best to meet the needs of patients and learn to communicate effectively, in assuring him / her that he/she is in good hands.