extension of this morn's Ischemic Limb seminar

Found a pretty good powerpoint on Acute Limb Ischemia.

Google:

clinical features to assess severity of ischemia

and hit the 1st link on the search results. :)

This page offers good stuffs. Bookmark it :P

http://www.medicaleducationonline.org/index.php?option=com_docman

err

i find myself spiralling along the course of extreme emotions these few days. its pretty freaky.

its a mixture of hvg self confidence but thinking you're not good enough, standing tough but also being scared, filtering influences of emotions from those around you. its enough to make you go from being very happy to anxious to being lost to getting your senses stabilized again.

maybe its the whole stereotype painted picture by seniors or friends, all well meant to let u noe what u're getting into or what to expect. but it creates this destabilization and at some point you wonder whr your own opinion stand or should stand or how u shud be. lol.

i'm in my 6th wk of Surgery posting. its dubbed most easy going compared to the other 2. although i'm less blur, more confident, hv more knowledge compared to like 1st wk lol, i feel like i'm stil so inadequately equipped. stil lack of so much knowledge n skill, stil so incompetent. n probably not hardworking enough. am i hardworking enough? do i have a definition or std to compare myself to? i nvr reli savoured the thought of comparing myself w others. bt then again without a benchmark u can get lost. i dont have a schedule or target or i dunno, sth along that line. i woke up this morning feeling reli alarmed. just a sudden shock n feeling of fear that i'm in week 6 bt stil so far from being prepared to leave the posting soon. and fear, is not a nice feeling at all.

swinging along the lane. i've starved myself of feelings i don't even know what to feel right now.

its not entirely negative. its just, so swing-ish that u're knocked into a different spectrum b4 u know it.

its probably exam jitters thats affecting ev1's mood. the medicine n O&G ppl have short/long cases coming up n the nervousness is sucking into me as well.

lalallalalallalla

it started as an Obligation. thereafter,

when Jesus looked upon the crowd of thousands who had gathered in front of him to listen to his teachings for days, his heart was filled with compassion for the hungry people. and through the breaking of loaves and fish, he performed a miracle that fed all of them and additionally filled up 12 baskets of the fish and loaves from an original 5 loaves and 2 fishes.

now. compassion. love. obligation.

when we look at our purpose in doing things, some are done based on obligation. some based on compassion and love. some based on obligation at first, but as time passed, you developed compassion twds it.

sth simple for instance. u enter this new school as a stranger. u obey the rules, u dun throw rubbish ard its compounds, u greet the sch officers bcz its ur obligation as a student to do so. but after 3 years, u've come to become so familiar with the sch that u noe ur teacher's favourite parking spot, the menu at the canteen everyday, the distinct off-pitched keys of the piano played drg assembly and without realising it, u have grown to be so fond of ur sch. u no longer pick up rubbish bcz its an obligation but bcz u love ur sch and simply cannot stand the sight of some1 littering or abusing its facilities.

some institutions use community service as a way to penalize their members for failure to abide to the rules n regulations of the institution. whoever started this system is a genius. the punishment becomes a contribution. and from this form of retribution comes err what's the word.. repentance? not exactly repentance but the 'turning over a new leaf' with changed life perspective that sort of thing.

bcz the individual starts off by say, washing the sch toilet very very grudgingly (bcz no1 likes washing the toilet) and he is embarrassed by the fact that he is subjected to this form of punishment. the 'pain' is thr (the agony of a bunch of cute guys walking past n seeing this girl washing the sch longkang - no that has nvr happened to me hehe) n at the same time, the cleaning is done, and when this so called 'horrifying' job has been done a tad too often, the person hvg been in that institution for some time would probably be doing it voluntarily. maybe not washing clogged drains, maybe beautifying the environment, or some form of community service like helping out in old folks or charity homes etc.

i used to enter hospital wards thinking 'okay, so today i will clerk 1 patient at least and do physical examination on 1 patient at the wards'. i want it to be convenient and fast and i hoped for patients to give their cooperation. i complained to friends when patients say they're tired / sleeping / wave me away. a day with mostly unhappy tired sleeping patients would be a 'not so good' day.

1 day someone's words struck me. 'if i see any medical student taking history from a patient in a hurried manner, doing it for the sake of taking history and not being genuinely concerned for the patient, i'll fail that student.'

whoops.

that kinda stuck in my brain even days after.

last week i happened to have a so called very free morning, waiting for teaching in the ward or sth, and i sat down to take history from a patient. not reli to take history, but just chat with the aunty (cz dunno y i was so free that time). and as i let her talk about different aspects of her life, telling me her job, her life, concerns etc, i found out more about her background and stuff pertaining to her current conditions in a way that i definitely wouldnt be able to understand if i were to skip to short questions like 'what did u used to work as b4 this? *answer* 'where're u staying now?' *answer* etc. and after the long chat, in subsequent days, i felt not to say compelled, but genuinely interested to find out how she was doing and feeling. and she opened up to let me ask anything at all about her condition. and when she was going to be discharged, i felt very happy for her.

in reality it is of course not possible for doctors to build rapport to this level with every patient they hav in hospitals or else they would be treating just 5-10 patients a day with 50 more waiting in line.

but i captured a little essence in caring for a patient not bcz it was mere obligation but out of compassion.

yes it might make a difference in her life, but also importantly, it makes a difference in your life when you do so. the wards bcome more alive, in a way. =)

i got that person to thank for his words. lol.

Patience

Is patience congenital or acquired?

there're many people of whom i simply marvel at their level of patience. patience in tolerating madness. the madness of traffic, people's attributes, annoying flies, longggg menial work, long hours of listening, practicing something to perfection, learning and trying until getting it, the list goes on.

somehow patience is linked to the amount of passion you have for something, or someone. the threshold level you have for different things and people differs.

the amount of time you would spend teaching your younger brother, the hours you would spend listening to your best friend complaining and offering words of comfort or just a listening ear, the lengths you would go to make sure your mother gets the best medical treatment, even if you had to travel miles and journey hours long to get something done, you would do it because your heart is in it.

the amount of time a doctor spends to listen to medical students present cases, correct them nicely, listen attentively and give constructive feedback, even though he noes he could be better off doing something else at that time and he wasnt reli obligated to guide and teach them anw. despite their lack of presentation skills and knowledge that equal to nothingness in comparison to the perhaps 10 years of experience down the medical line of his, he takes in all questions, drills and explains concepts even with tired watering eyes.

at that point i was wondering if this doctor had the patience to do all that because of an inborn strike (not error :P) of patience or bcz he had the passion to teach or sth along that line.

its a remarkable trait that truly inspires students. sometimes a part of the reason that you are motivated is bcz u dun want all that patience and time invested to go to waste. and it also challenges you, to give back that kind of patience to society, acquantainces, ppl you hardly or dont noe and to do things that you dont like doing.

Unintentional harm

Ppl were born with the natural instinct to do wrong. If u realized, we weren't taught to carry out actions that are by society's standards or universally accepted as immoral i.e. lying, hurting others but these were inherent, as if a human nature. No one taught the 3 year old child to lie but he did so to save himself from perhaps punishment or repercussions of his actions. Sensing danger, he by all means tries to run away. Another illustration. The 4 year old boy refuses to admit he scribbled the wall because he was afraid of being scolded. Obviously no one taught him 'to lie to get away' prior to that. He did it by human instinct. You get what I mean. (if u beg to differ u're welcome to share ur opinion of course) but that isn't my main point here today anw.

 

When we do something that has unintentionally hurt others, we hope to clarify things, clear doubts and make amends to the person, to let him/her know that it was unintentional and we're sorry. Of course this doesn't give us the right to continue being ignorant n to hope for mercy each time we unintentionally hurt others. Bcz when it happens too often and repeatedly, ppl get tired of it and you know sth isn't right (with the way u're handling things). Whnever we're given the benefit of the doubt or are spared of our mistakes (or not), we take a lesson out of it, make a mental note and continue to mature and learn to be more and more tactful. In that process, we continue to salvage on open and forgiving hearts of ppl ard us to look past our misgivings.

 

Becz the point here is: None of us (well most of us anw) inherently wish to hurt others.

In whatever aspects and by whatever way.

 

So that brings me to the main point lol. Sorry for being sooo long winded.

Ppl around us (our friends / associates / family mbrs) who have caused hurt to us / our loved 1s / our friends / others could have done it unintentionally. Certain actions that we think are unacceptable by Our standards, may be acceptable by another person's standards. It differs bcz we were brought up in diff fam backgrds, a layout of society with diff expectations n needs and diff levels of tolerance.

 

The individual, did not realize he/she has caused hurt to another fella bcz:

1. If he/she were to be placed in that situation / commented w the use of certain words, he/she feels its alright n wouldn't be offended bcz he/she has a higher threshold level in accepting criticism.
   
2. He/she feels it's alright to be messy / borrow things without permission / leave things around etc. bcz he/she wouldn't mind for others to do likewise to his/her room or things.
   
3. There was a communication breakdown whr sth said meant a different thing/ Is interpreted differently by two diff individuals.
   
4. His/her standards of 'normal' differs from everyone else in our clique.
   

Brain jam. There are a 101 reasons that can be listed out.

 

Therefore, before we start judging / condemning / labeling a person for an action we disapprove of, we need to remind ourselves that:

1. No1 likes hurting others. (the definition of none is of course not absolute, well you know what I mean cz I'm lazy to list out exclusion criterias lol) It could most likely be unintentional.
   
2. Humans inherently have a tendency to do wrong, but as we mature and bcum educated, the norms of society/our surroundings and our conscience determines to what extent we inhibit sinful tendencies and do the 'right' things.
   

 

In order to evaluate that person, we have to rightfully

• Clarify matters, find out reason he/she did that blah
  
• Find out if it was intentional or otherwise
  
• Let the person know how and why his/her actions were hurtful or deemed to be wrong by others.
  
• And of course doing all the above in a very very tactful manner at a correct time.
  

 

If I had hurt sum1 unintentionally and did not realize it even til much later, I would appreciate it very much for ppl to tell me that and how was I wrong by the 'standards'. Not to be spoken of behind my back and deemed to be horrible by everyone else.

 

Well yeah, most ppl in society however prefer to take the shortcut and skip right to spreading juicy gossips about others. I dun deny this shortcut is easy and tempting to take (by inherently sinful nature hehe).

 

I therefore stil need to continuously remind myself to walk the longer road, take that extra mile of reflection and at the same time, try reduce unintentional harms towards others. J

 

We don't just need communication. we need effective communication.

 

*this post was written by random thought and is not linked to any specific personal encounter/experience.

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