Back to Hervey Bay

It’s the beginning of the second-to-last rotation: obstetrics and gynecology. I will be spending the first four weeks of the eight-week rotation back in my old haunt Hervey Bay.

The med school is putting me and another fourth year up in a house in a new subdivision just behind the hospital. Driving down the new road behind the hospital, I can’t help but notice that the neighborhood in front of me could have been airlifted straight out of Anywhere, USA, and plopped down in the middle of Australia. The same denuded landscape that had been clear cut to make way for cookie cutter houses, the same manicured lawns with feeble saplings propped up by supporting frames, the same deserted streets in which the only indication of human inhabitation are the cars parked in the driveway. The elegantly designed Queenslanders that are built and oriented to suit the warm and humid Queensland climate have given way to the cheaply and massed produced prefab homes. Another unique regional feature has died a quiet death by the forces of McDonaldization of the Western world.

This sterile neighborhood will be my home for the next four weeks.

In the morning, I walk over to Hervey Bay Hospital that had grown so familiar to me last year. Walking down the central corridor like I had countless times before, I keep running into junior and senior doctors who had taught me last year. To my surprise, they all recognize me and stop to chat. Sure, there were only ten of us here last year, so they didn’t have to deal with a thousand med students coming through day in day out. But stopping to chat with a lowly medical student? That’s way beyond what I’d expect big shot doctors would do. And yet, there I am, shooting the breeze with the head of surgery, being asked about my elective in Zambia by the consultant in medicine, listening to another surgeon recounting his OB/GYN rotation during medical school.

It’s nice to be back in Hervey Bay.

Later, Hervey Bay

I didn't think I have that much stuff. But after I put everything in boxes, backpacks, and bags, the spread in the living room starts to get me worried. I may not be able to fit everything into my little car. A second trip - an extra eight hours - is looking depressingly likely.

Not one to be discouraged, I fold down the backseat and start putting boxes into the car. One after another, bit by bit, every inch of room gets filled by my stuff. At the end, as if defying the laws of physics, all of my crap is crammed into the car. I can even see out of the left rear-view mirror!

So with the car packed to capacity, I drive out of the Hervey Bay Maryborough Road for the last time.

Whoa, We’re Halfway There!

Woohoo! Exams are over, and I am a free man for the next two months. How I need the break, especially after such brutal exams yesterday.

The exams were in Bundaberg, a little over an hour away from Hervey Bay. They were horrible. I must have looked terrified while I was sitting in the lobby of the hospital waiting to get called in. Nurses, wardies, and everyone else who walked past me stopped to tell me, “It’s not that bad.” After an excruciatingly long wait, I was finally given my patient. Then the rest happened so fast, I hardly noticed that time just flew by. At the end, the examiner said cryptically, “I’m not allowed to give you feedback at this point. But enjoy your break and I’ll see you next year.” Yeah, hopefully not in the same scenario.

I spent the rest of the day stewing over little details that went wrong in the exams and every answer that I got wrong or needed prompting for and the awkward silences when I didn’t know what to say, until the evening when I got together with a few of the doctors from the medical team and had mulled wine. Ah, alcohol, I am so glad we are friends again.

Today’s plan: pack up everything I own into my car.

Tomorrow: drive to Brisbane.

Sunday: fly out to California.

Next Wednesday: off to Washington, DC.

And that’s just the plans for the next seven days.

It’ll be a good summer break.

Waiting for the Execution

Tomorrow I will be taking the exams for medicine rotation, and I am feeling restless, unable to concentrate, and in complete sympathetic overdrive. Studying? So over it. I have been staring at the pages of my books and nothing seemed to have gotten through. This afternoon, feeling like I was getting nowhere with studying, I went to the pool for a swim. After jumping into the pool, I felt like my arms were made of putty and just wouldn’t cooperate to allow me a good swim. After splashing around in the lane for a half hour, moving like I’d just learned to swim, I gave up and walked back home.

I don’t know why I am feeling so nervous. You’d think after having taken so many exams in my life, it wouldn’t be a big deal anymore. Maybe it’s because the whole exam is live, as opposed to written like almost all of the other exams I’d taken before. Maybe it’s because my grade for the whole rotation will be from the exam tomorrow. Or maybe it’s actually excitement from knowing that I am one day away from a two-month holiday.

I take my pulse. Forty-eight per minute – pretty normal for me. Maybe I am not that nervous after all. But my palms are sweaty and have been for the last three days. I feel like I am waiting for my execution tomorrow, watching the clock tick away, dreading the inevitability of it but, at the same time, looking forward to when it’s over.

All right, no more studying. I am going to watch some video clips on Youtube and hopefully I will get tired at some point.

It's Only A Five-Step Job

I see this sign everyday. It is posted in one of the staff toilets on the medical ward at the hospital where I am doing my medicine rotation.

It only takes five-steps!? And with illustrated instructions!! To change a roll of toilet paper? I wonder how many toilet-paper-roll-changing mishaps it took for someone to take the time to make and post these instructions. But it gets better. Someone else must have thought, “Five steps? That’s too complicated. I’ll simplify things a bit,” and wrote down the “Alternative Directions” next to the printed instructions.

Every time I look at it, I feel like I am reading a manual for defusing bombs. Okay, maybe not, but this is definitely the first time I’ve seen a toilet paper roll holder that needs an owner’s manual.

~~~~~~~~~~

Tonight’s dinner: herbed chicken risotto with green beans, and a salad.

Not the Sharpest Knife

With two weeks of the rotation over, I am finding myself getting less stressed out by not being able to answer the impromptu quizzes thrown my way on a daily basis. I must be getting used to it. On a good day, I may be able to answer half the questions. Sometimes when my rotation partner and I get grilled together, it really takes the pressure off, even if the other person is just standing there for moral support. Other times, I am give a reprieve and get sent to do some practical things like putting in cannulas in patients’ arms and taking bloods. My fine motor skills are leaps and bounds better than my ability for memory recall. Find a vein in a frail and dehydrated old lady with paper-thin skin big enough for a medium gauge cannula? No problem, I’ll give it a go. List the causes of pleural effusion? Out of the dozens of causes, I’m stuck after listing four. If the career of a physician is predicated on the ability of memorizing long lists, I may have better luck at surgery where manual dexterity counts for something.

Post Mortem

Eight o’clock, my rotation partner and I walk through the green doors. In front of us, the body of an old man is perched on top of a stainless steel cart. Next to the cart is a sink with a spray hose and a stainless steel bench with a cutting board. To the right is a bench with various sharp tools designed to cut through any organic material. The man on the cart died suddenly last week at home. Today the pathologist is going to perform a autopsy and try to find out the cause of death. In Queensland, all autopsies have to be witnessed by the police, so two police officers are also present.

In walks the pathologist. We exchange greetings and he starts working. Wielding a scalpel, he expertly makes an incision from the man’s jawline, down his neck, through the middle of his chest and abdomen, all the way through to the pubis. As he peels back the chest tissues and abdominal wall, the room is immediately permeated with the smell of three days of decomposition, despite the refrigeration. I look around: the smell does not even register with the pathologist, my rotation partner and the police officers start breathing through their mouths. Luckily for me, I am not bothered by the smell. Having peeled back the man’s chest, the pathologist takes a bolt cutter and snaps the ribs one by one until he can lift up the whole front rib cage off the chest like popping the top off a tin can. Next, he frees all the internal organs from the chest and abdominal cavities, slices the tongue from the mouth through the chin, and in one fell swoop, picks up the whole collection of internal organs from tongue to anus and everything in between and lays it down on the bench. The pathologist’s assistant picks up the oscillating saw and goes to town on the skull. In no time, the brain, covered in its fine web of arteries, is presented to the pathologist.

Each organ is weighed, catalogued, sliced, and examined for abnormalities. In the mean time, the pathologist’s assistant sews up the body, leaving a small opening in the abdomen into which he puts a plastic bag. All the chopped up organs are returned to the body into the bag, like so much table scrap being swept down the garbage disposal. The whole procedure is cold and clinical, without any emotional attachment. The person on the table was someone’s father, someone’s husband, someone’s grandfather; but in here, he is just a body whose cause of death the pathologist is trying to determine.

Toward the end of the autopsy, the door to the room swings open. Another body is brought in on a steel cart. “Suicide by hanging,” announces one of the wardies, pointing to the noose still around his neck. The pathologist’s assistant takes the spray hose and cleans off the ants still crawling on the body, then pushes him into the morgue. “We’ll do a post mortem on him later to make sure it was a suicide and not a homicide,” says the pathologist.

With that, the autopsy comes to an end. We thank the pathologist and head to the ward.

Back to the Grind

I am scared.

Today was the first day of the last, and the toughest, rotation this year: internal medicine. Ward round started in the intensive care unit, where I met the consultant I would be attached to for the next four weeks. Immediately, I found myself struggling to answer the questions he threw at me as we saw each patient: chest x-ray interpretation, causes, investigations, and treatments for secondary hypertension, community-acquired pneumonia, and heart failure. Standing in front of the consultant to my left, a senior medical officer (SMO) and a principal house officer (PHO) to my right, I tried to wrestle my brain back from the beaches of Fraser Island as steam started to build up under my collar. It was like playing dodge ball while being chained to a fence post. Two hours later and satisfied that I got a taste of what was to come in the next eight weeks, the consultant left; my battered body sat in a heap on the floor. I picked myself up and finished ward round with the SMO and the PHO.

I finished the day with a long list of things to look up: too much information to learn, too little space in brain.

Four Down, Six To Go

Another rotation is over! That means another week off. What do I want to do with myself for a whole week?

I could lounge around and do nothing (and be bored to death), I could go to Brisbane (not all that exciting either), I could study ahead of time for the next rotation (yeah right, as if), or I can do what I have really enjoyed doing for break this year. How about going to Fraser Island again? Six days, 100+ kilometers, me and nature. Sounds like a good idea. This time will be even better, because my mates James and Mike from Brisbane are coming up to join me for the walk.

Good times!

Wrapping Up

Where did the rotation go? It feels like I just had exams last week and all of a sudden it's time for end-of-rotation exams again? I guess I shouldn't be complaining; it probably means this GP rotation has been so good that time just flew by.

In the last seven weeks, I have seen more sore throats, coughs, and tonsillitis than I care to count. But it was presentations like hyperthyroidism, management of diabetes-related complications, evaluation and dressing of wounds, and hands-on procedures like cutting out skin lesions and suturing cuts that made the days full of variety; an eight-hour day would be gone before I knew it. The days were definitely more than just about "tears and smears" (tears - depression; smears - Pap smears) that specialists often say disparagingly regarding general practice.

Another aspect of GP I find enjoyable is that GPs, at least the good ones, really do treat the patient and not just the disease. Specialists are like service stations where patients stop to get their problems fixed, but GPs go on the journey with them. Getting to know the patients as people, not just someone anonymous with gallstones or broken wrist you probably will not see again, is what really appeals to me. This rotation was the first rotation in which I had a lot of one-on-one contact with patients. They seemed to like me well enough. And it was reassuring that most patients found me easy to talk to. Some of them even called me "doctor." By now, when the patient says "doctor" at my general direction, I find it a lot easier to suppress the urge to look around to see where the doctor is.

Well, all good things have to come to an end. Now I have to study for exams, the bane of my existence! Why does a rotation so enjoyable have to end this way?

Shamu!

After a week of gray and wet weather, the sky cleared up again today and the weather returned to the normal winter day in Hervey Bay - dry, sunny, and warm. I felt like I was coming down with cabin fever after a week of being indoors - I tried to study but I couldn't sit still and had the attention span of a nat. So I went to the pool and had a swim to get it out of my system.

The Hervey Bay Aquatic Centre, with a 50-meter pool open for the summer and a heated 25-meter pool open year-round, is where I go for a splash every few days. A lot of people consider swimming pretty boring. In a way, I guess it is: all you see is the black line at the bottom of the pool, all you hear is water sloshing around, and you don't get to listen to your tunes during the work out. But that's the appeal for me; it's a sort of sensory deprivation that I find therapeutic. Also, you don't get sweaty as your sweat is constantly being washed off. No music? No problem. I just set my mind free and let it wander. At some point, a soundtrack would come out. I don't pick the tunes, it just plays. Today's soundtrack consisted of the leitmotif of Requiem for a Dream, which morphed into Carmina Burana, which then turned into Santana, and then Branford Marsalis popped up, which carried me through the cooldown lap. See, who needs an iPod when you've already got one built in?

Feeling spent after the 2-km swim, I made myself a protein shake, then started making dinner. I know I am going to sleep like a coma patient tonight.

~~~~~~~~~~

Dinner: simple but tasty stir-fried lamb and broccoli

House of the Setting Sun

I went to a nursing-home visit this evening. It was a high-care facility where all the residents are highly dependent on the nursing staff for even their most basic daily activities like going to the toilet, feeding, and showering.

Walking through the front door, I was immediately surrounded by that characteristic "old folks home smell," a mixture of antiseptic solution, stale air, urine, and the occasional heavy scent of air freshener someone had sprayed in a vain attempt to make the air more breathable. With my olfactory glands quickly and fully saturated and desensitized, I walked with my GP down the hallway starkly lit with fluorescent lights and decorated with generic paintings of flowers. The paint on the wall and the lighting together gave off an eerie green-hued tinge to everything inside.

We went from room to room, visiting the dozen or so residents my GP was responsible for. Some gave a half response to our questions, others were loquacious and intent to chew our ears off. Some had their mental faculties more or less intact and were sitting in the dining room chatting to other residents, others were so demented they were only a shell of their former selves lying in bed completely unaware of their surroundings. Some had pictures of their families and flowers next to their beds, a result of their families trying to make their corners of the rooms as homely as possible. Others seemed not to have anyone left in this world, with the walls and nightstands on their corners of the room completely bare and not a sign of visits by anyone was detectable.

My GP started to review the drug charts. Anti-depressants, sedatives, and stool softeners seemed to be the staples of the elderly population in the nursing home as they are in the community. One by one, the charts are reviewed, the drug dosage adjusted; then the stack of charts are set aside like a pile of freshly-finished homework.

"This place is so depressing." I commented to the nurse.

The nurse chuckled, "Well, it can be depressing. But you get used to it."

For the residents here - some of whom depend on anti-depressants to even get the energy to chew their bland meals, who are on sedatives and kept in a low-stimulus environment so they can sleep their days away and so the overworked nurses would not have to deal with any delirious residents, to whom a 5-minute visit by the doctor once a month may well be their only contact from the outside world other than the nurses - the remainders of their lives are no more than a disorienting drag from one meal to the next in an infantilized existence. The flickering images on TV no longer mean anything; it might as well be showing an alien world on Mars. Are the residents with more or less intact mental faculties thankful for being alive each day, or are they envious of the demented ones who are blissfully ignorant of their terminal predicament?

The visit came to an end. As I walked past the front doors, I took a deep breath of the fresh cool night air. I reminded myself again that I am here as a health care profession (albeit one in training) and despite my personal opinions, these residents are here to stay; all we can do as doctors and nurses are to make their last days as comfortable as possible.

Tonic for Perpetual Health

As part of the GP rotation, I had a visit today to an audiologist, one of the allied health professionals in town. An audiologist does hearing tests, fitting and fine-tuning hearing aids for people with hearing loss.

I sat in on a hearing test on a young man in his mid twenties who had lost most hearing in his right ear after a few years of working in a saw mill with only occasional use of hearing protection. Afterwards, the audiologist took out the file for the next patient.

"This next patient is a very interesting lady. Now, just take off your medicine hat for a minute. Other than needing hearing aid, Mrs. S____ is in exceptional health. She told me her secret on her last visit. There's something she drinks every day to keep her health, and she swears by it. Whatever ails you, diabetes, cancer, high blood pressure, anything, her drink cures it. She gave me a small bottle of it."

Okay, it must be another one of those juice of the month that claims to do everything for you. I waited for him to pull out some exotic juice from a far-away land.

Beaming, he opened a drawer and pulled out a clear bottle with a red label containing some clear fluid. The label proudly declared "Stolichnaya Russian Vodka." "Vodka?" I said incredulously. "Yup." Well, I guess you could call Russian vodka an exotic juice from a far-away land.

The audiologist opened the door. Mrs. S____, an elderly woman walked in and sat down. "Did you drrrink the vodka today?" she asked the audiologist in her thick Russian accent. "No, not today," the audiologist confessed.

Giving him a disapproving look, Mrs. S____ then turned to me and asked, "Do you drrrink?" "Not vodka," I answered. "Why you don't drrrink? It make you strrrong! One cup a day, I drrrink."

After the session, Mrs. S____ turned to me as she walked out the door and said, "Next time, I brrring you some."

Where else but in primary care would patients offer health advice to their doctors?

~~~~~~~~~~

Tonight's dinner: broiled salmon with Chinese five spices on Chinese cabbage and blend of jasmine/brown rice.

GP Land

It's been two weeks since the start of GP rotation and I'm digging it. Coming out of mental health rotation, I am glad to get back into the medical side of medicine. Dr. R., the GP I am following lets me see patients on my own (under his supervision, of course) and do a lot of the procedural work like cutting out skin lesions. Sitting in my own room seeing patients is the perfect way for me to try out this whole GP thing.

One aspect of general practice that appeals to me is that you never know what's going to walk through the door next. One patient could just have a cut that requires suturing, the next patient could come in with four chronic conditions that require full reviews. Another aspect that appeals to me is the continuity of care. When a patient comes in with something that probably requires an operation, you refer them to the surgeon. When they come back later for a follow-up visit, you get to see the patient in recovery and check whether your clinical suspicion was right in the first place.

~~~~~~~~~~

Today a patient came in complaining of bumps on his back that had been there for years. One of them grew bigger and painful over the last week and he was concerned. After taking more history and examining the bumps, the big one being about three centimeters in diameter, I made the diagnosis of sebaceous abcess, or in layman's term, a giant inflamed zit. I called Dr. R. into the room and presented to him my findings. He agreed with my diagnosis and proceeded to explain to the patient that it was not anything bad and the best way was to leave it alone. Standing next to Dr. R., I asked, "In what situation would you decide to drain it?"

He looked at me, as if thinking "ooh, you're going to be sorry you asked." Then said, "We can do an incision and drainage now, do you want to do it?"

Not knowing what I was getting myself into, I said, "Sure!"

Up the patient went onto the procedure table. After I injecting the local anesthetic, Dr. R. explained to me, "Just use the scalpel to lance the abscess, but watch out, it could be under a lot of pressure and the collection of pus could come out with a lot of force." Handing me the scalpel, he said, "You'll know when you've lanced it. You'll smell it. If you need anything, just come get me in my room," then walked out to see the next patient.

I was left holding the scalpel thinking about the giant zit exploding in my face. Gingerly, I positioned myself to be out of the possible trajectory of the pending explosion, then pushed the scalpel down the center of the abscess. No explosion happened. I breathed a sigh of relieve and my nostrils were filled with the sour and acrid smell of pus. Yup, Dr. R. was right. For the next ten minutes, I poked and squeezed the abscess and wiped away the cheesy blood-tinged pus. Finally, having squeezed the last drop of pus from the abscess, I put the scalpel down. Dr. R. walked in, checked my handiwork, and said, "Good job, Tony." Now I knew why he had wanted to leave it alone and let it pop by itself. I asked an innocent question but got the answer the hard way.

Well, it was all part of the learning process. At least the patient felt better right away and did not have to deal with the pressure on his back anymore. Though next time I may want to do it in a place with better ventilation.

~~~~~~~~~~

Tonight's dinner: broiled mackerel in ginger marinade on Chinese cabbage and sweet potatoes.

Three Down, Seven to Go

Walking out of the last of three exams for mental health rotation today, I expected to feel the weight lifting off my chest like it did before. But no, that feeling never came; that sense of relief, of having accomplished something worth celebrating, never arrived. I had been looking forward to the end of exams for quite a few days, though. So maybe all the anticipation has made the moment rather anticlimactic.

Regardless, it's the beginning of another one-week break! Big plans are in store: a 100km trek through Fraser Island. Two months ago I went with my mate James and walked the southern portion of the Fraser Island Great Walk. The walk I have planned this time is a loop that takes in the northern portion of The Walk and a 25km stretch of Seventy-Five-Mile Beach. James is busy next week and no one else seems interested in doing the walk, maybe it's because of the distance covered, or maybe it's the -2 degrees centigrade overnight low on the forecast. Where are my hardy, outdoorsy friends when I need them? Looks like I will just have to do it solo, with a good thick book as my trusty companion.

I'll be off to Fraser on Sunday. Will write all about it when I get back.

What Exams?!

It's the weekend before another round of exams. And for the life of me, I just can't get motivated to study. So I do what I do best under these circumstances - procrastinate, something I have skillfully mastered after spending most of my life as a student. Cleaning, doing laundry, fixing up my bike, day-dreaming, reading about photography, going to the marina for coffee, making dinner, and blogging about procrastination - it's been a success! I have avoided looking at anything that has anything to do with psychiatry for a whole day.

Perhaps this is the manifestation of my ambivalence towards psychiatry. I'm ready for the rotation to end, not that I have any ill feelings about the specialty. To the contrary, I think it's a very important field without which medicine wouldn't be complete. From what I've seen, it's the only field in conventional Western medicine that treats its patients with a holistic approach, the whole biopsychosocial model med schools are so desperate to teach to the next generation of doctors. During this rotation, I have seen plenty of patients whose debilitating mental illnesses have been treated and managed well enough to allow them to initiate steps toward getting their lives back on track. So I don't think psychiatry is not "real" medicine, it's just that I don't think I can hack it.

Many people say, and I also believe, it takes someone with a certain personality to do psychiatry. By "certain personality," I don't mean crazy. Talking is of paramount importance in the field. Because there is no lab tests for most psychiatric illnesses, results from history-taking, or interviews, are the only information available to diagnose them. Conversational and interpersonal skills are essential for a successful interview. The ability to make people relaxed, to accurately read people's body language and their tone of voice, to ask questions in a way to solicit useful answers are all qualities in this "certain personality." A psychiatrist would have to be, in a way, manipulative to get the information he needs for an accurate diagnosis. I'm the first to admit that I'm not a great conversationalist. Sure, that's what the years of post-grad training program is for. But why train a monkey to walk on two legs when he's really good at swinging from branch to branch?

Another reason for psychiatry to be not my cup of tea is that I find its inadequacies frustrating. The mental health inpatient unit works in a somewhat revolving-door fashion. Patients present acutely, they are treated until they are well enough, then they are discharged, only to present again soon after with another acute episode that requires admission. Part of it is that psychiatric illnesses are chronic conditions, and part of it is a reflection of our social problems. Most of the patients reflect a cross section of society that is in many ways confounding their treatment: homelessness, neglect, abuse, self-harm, social isolation... Often times, psychiatry warps into social work, balancing the safety of the patient and the community against the need for an empty bed that will be filled by the next admission waiting in ED, knowing the patient will probably re-present acutely before his next outpatient appointment. In this regard I am impatient, I want instant gratification, I want tangible results now. I prefer surgery where the patient presents with a problem, a diagnosis is made, followed by surgery, the patient makes a recovery and is discharged; case closed. The idea of presentations that end with definite results, whether good or bad, appeals to me. That's something psychiatry tends to lack.

This rotation not only gave me new-found respect for psychiatrists, but also helped me put psychiatry lower on the list of possible future careers. Like they all say, it's not you, psychiatry, it's me.

And with that, I have killed the remainder of today. Good job.

~~~~~~~~~~

While ruminating on the topic of psychiatry, I cooked up tonight's dinner: vegetarian fettuccini topped with grilled haloumi and avocado.

Going Mental

Last week was the first week of mental health rotation. The mental health inpatient unit has fourteen beds and they've been full most of the time. Mental health service has come a long way since the days of Bedlam. The big institutions are all gone; no one gets committed anymore. What's left now are acute services and patients are discharged to the community. And then there are the rules. All the rules and regulations that ensure the proper treatment of patients while they are at their most vulnerable directly translates into mounds of paperwork. I know paperwork is an unavoidable part of medicine, but mental health definitely takes the cake in this aspect. The doctors are constantly writing in patients' charts and filling out forms.

I sat in on patient interviews all week. Listening to their stories and hallucinations, hearing them describe the way they perceived the world around them, I felt like a voyeur peering through a keyhole into their psyche. This catatonic patient who worried about every minute details of daily living, that floridly psychotic one having a complete breakdown, this one with delusions of grandeur who absolutely believed in his story, that schizophrenic one who was constantly arguing with the voices in her head - it was like watching a drama, a comedy, a tragedy, and a film noir all rolled into one. From day one, the med school has been teaching us to empathize with patients, to understand where they are coming from. But it looks like psychiatry wound have to take exception to that rule. The hardest part of psychiatry is probably learning to not empathize so much that we start to identify with the patient - in order to maintain insight into the patient's problems, but more importantly, for our own sanity.

It's going to be an interesting rotation.

~~~~~~~~~~

Tonight's dinner: chicken cacciatore on cous cous with silverbeet.

Two Down, Eight To Go

Yay! Another rotation is over! My exam this morning marked the end of the surgery rotation. All of a sudden I found myself with free time and no studying waiting to be done. With a week off until the next rotation starts, what am I going to do with myself?!


I live only twenty minutes away by foot from the beach, but I haven't gone there in a while. So after lunch, I decided to get on my bike and ride down to the beach. I wanted to do some reading, but most of the books on my sagging bookshelf are my med books - the last thing I want to open today and for the next week. So I stopped by the local library and checked out a non-med book.


Every time I go to the library browsing for a good book to read, I invariably end up in front of the travel section - whether it's travelogue or travel guide, I always end up checking out a few of them. Now, armchair travel normally just doesn't do it for me. But when traveling is not possible at the moment and is not even remotely on the radar, I'd have to live vicariously through other people. So I picked up Greater Nowheres: Wanderings Across the Outback, a book about a couple of journalists driving across the Australian Outback in pursuit of the deadly salty - the salt-water crocodile.

Then I sat on the beach and started to read the book until the sun set. Not a bad way to end the day.

Friendly Fire

It was just another day in the operating theater, anther lap chole. I scrubbed in with the surgeon. My role was, again, to hold retractors and cut sutures, etc., which I didn't mind. I've always enjoyed assisting surgeries, no matter how minor they were.

As I stood next to the surgeon holding a retractor, he released a flap of tissue with the pair of toothed forceps he was holding and bumped against my hand. "Sorry," he said and proceeded to the next task. As I handed the retractor back to the scrub nurse, I noticed a nick in my glove. "I think I have a nick in my glove," I told the scrub nurse. "You'd better change that," replied the scrub nurse. As I took off the glove, I saw a bit of blood right where the nick was. "You're bleeding," said another nurse. "That's a needlestick incident. You'll need to unscrub, fill out an incident report, and go to A&E to get your blood tested."

That was how the rest of my afternoon was taken up by writing an incident report, opening a patient file for myself at A&E, getting blood drawn, etc. I didn't even feel the forceps puncturing my skin and the blood on my hand may or may not have been mine. The chances of picking up diseases this way is extremely small. But to follow protocol and for safety's sake, I'll be having my blood tested for Hepatitis B and C, syphillis, and HIV, among other nasty blood-borne bugs. And again six months later.

Well, I'm not going to lose sleep over it because sometimes, shit happens. Plus, I need my sleep so I can study for the end-of-rotation exam this Friday.

~~~~~~~~~~

Tonight's culinary experiment: pita wrap with baba ghanouj, chicken, zucchini, roasted mushrooms, and yoghurt sauce. It wasn't too pretty, but was highly edible. I made baba ghanouj with extra garlic a few days ago and the garlic flavor has definitely intensified since. Hmmm, postprandial garlic breath...

Hand-Eye Coordination

I assisted in a laparoscopic cholecystectomy today, in other words, key-hole gall bladder removal. It was my first time driving the laparoscope camera, and it showed. My hands were far from steady, not because I was nervous, but because of my unfamiliarity with the instrument and, apparently, my bad hand-eye coordination.

You know how when you cut your own hair with a pair of clippers, you use two mirrors, one hand-held and one on the wall; when you try to move the clippers while looking at the back of your head through two mirrors, they often go the opposite you want them to go? No? Am I the only one still cutting my own hair? Okay, maybe I'm the only one. But if you do, you'd know what I'm talking about. Handling the laparoscope camera was a bit like that. Every move I made was amplified on the TV screen, so the surgery started to take on a bit of the "Blair Witch Project" quality after a while. Well, maybe that's a bit exaggerated, but I don't think the surgeon was too impressed with my camera work.

Afterwards, I had a brief exchange with a junior surgeon:

Junior Surgeon:
Do you play video games?

Me:
No, not really.

Junior Surgeon:
I could tell.

Me:
Does Minesweeper count?

Junior Surgeon:
You know what I do? I play Flight Sim.

So video games is the solution! Oh, I so wish I could go back in time to junior high and tell my mother, "No, mom, I'm not 'just wasting my day playing video games,' I'm training for my future career as a surgeon!" Yes! guilt-free video game sessions! Now, where can I find Flight Sim?

~~~~~~~~~~

Speaking of gall bladders, I saw a news article about a brand new approach to removing it. Don't want scars? How about let's go through a natural orifice? Hmmm, how about the vagina? A team in France performed a transvaginal "no scar" cholecystectomy, and another team in New York did another one. What'll they think of next? Removing the appendix through the mouth? Wait, that's a possibility too! Crazy surgeons.