Sunday, July 03, 2005

In the dark of the night

It's Tom Cruise's birthday today, and I present you with this crazily funny video: Darth Cruise kills Oprah! It's wickedly funny, and I put it on loop on my comp to amuse myself endlessly. If you haven't watched Revenge of the Sith then it's probably not too relevant.

13 days to Harry Potter and the Half-Blood Prince! The anticipation is killing me, but I have the feeling that I won't have the time to read it.

[This marks the start of an inundation of medical student jargon, so you can skip this part if you wish. ^___^]

A long overdue account of my night duties on Wednesday night. All in all I call it a live-changing experience, because it certainly felt that way to me, though of course I may be over-dramatising things, like I always do. The more I describe my night to people the more it appears totally mundane, so I suppose it must be, but despite the mundane-ness some of the things I saw touched me at a far deeper level and made me think about a lot of things, things that aren't exactly easily described in words.

The registrar on night-call was wonderful. A gastroenterologist (I seem to have a lot of affinity with gastroenterologists, being in a ward with a GE consultant and associate consultant in CGH, and having a GE main tutor in NUH now), he sounded really friendly on the phone even though I paged him at 4.30 p.m. while he was in the middle of scopes, and asked me to join him in the scope room. That led to my discovery of the Kent Ridge Wing (oh, my ignorance index is way up there as usual), but not after peering at the level directory on every level of the NUH main building and eventually asking someone where the Endoscopy Centre was.

At the scopes room I saw the end of one OGD, and was asked some routine questions about the urease test (he asked me at which pH does phenolphthalein change colour, and I gave the wrong answer, haha). Following that was a pretty problematic colonoscopy. It appears that colonoscopies are generally harder than OGDs, well duh. Some doctors popped in to talk to Dr. R, the reg, and one of those doctors was Dr. D, who was on TV lately! Mwahaha evil fanboy grin. No I'm not a fan, just that it's somewhat interesting to see someone in the flesh when you've seen the person on television. So kill me for loud inner squealing.

Scopes ended at around 6.30 p.m., and then it was off again. I really need to learn how in the world doctors walk like they're on high-speed travellators; most of the time I was trying very hard to keep up with my registrar, and I think he was trying not to leave me behind. And walking around for many hours in leather shoes is like, so not good for your feet. Dr. R got paged to see a patient referred by some consultant, which we both went to see. A very interesting experience, not because of what the patient was suffering from but because both her and her daughter were doctors. Can't say more without landing myself in potential hot soup. But I got my first taste of the amount of stress that family members can exert on a doctor, and learnt how important it is for a doctor to keep an open mind.

7.40 p.m. - Dr. R decides that I won't get to see much following him because he's just going to check up on some of his patients here and there, so he sends me off to an MO in ICU. The MO expressed no small amount of disbelief when I arrived at the ICU, as did the registrar who was doing the handover rounds. Some things along the lines of "A 3rd year medical student? You're totally out of your depth here". And I was, really. Following them around the ICU was a good experience to see what the ICU actually looks like, and look (like a boy who finds himself in Toys 'R' Us for the first time of his life) at all the machines that patients are connected to there, but as the MO told me, a lot of the cases in the unit are really complex and not too suitable for a medical student to learn about.

At about 8.30 p.m. I was shunted to the wards to follow another MO, Dr. SY. Nothing much to note here except I learnt what AOR is because she had to talk to the relatives of a patient who wanted a discharge against doctor's advice. We went over to Ward 55 after that to see a patient who had respiratory problems and a low saturation despite being on 50% oxygen. Apparently the relatives were quite difficult and angry that the HO on duty, Dr. HY, had not updated them on the patient's condition. The nurses came and performed suction through the patient's tracheostomy because his secretions were obstructing his airway, and at one point the nurse extracted the suction tube to show a long off-white clump of secretions. I helped to hold the patient down as the HO took ABG samples and venous blood, so I suppose that counts as observing a procedure, haha.

The only procedure I actually ended up doing was an ECG, which isn't exactly rocket science. The HO seemed pretty stressed and asked if I could help her do some procedures, somehow assuming that I've actually done stuff before, so I went and did the ECG. Just place all the nicely labelled electrodes at the right places, switch on the machine, press a button, and voila, all's done! Thankfully a nurse happened to come by as I was doing it and I could double-check with her that I was doing things correctly. I was also supposed to set a plug for the same patient I did the ECG on, but despite the HO telling me that he has a nice big vein I didn't think it was that nice and big when I was there, and to top it all off the plug apparatus in NUH is different from the CGH ones and I just couldn't find the right ones because there weren't any in the trolley. Eventually after asking the nurses about the IV plug they reassured me that the patient didn't need one and sent me back to the HO. It was actually the MO who wanted the HO to set the plug, I found out later, and felt totally bad for not being able to help, especially since the HO had tonnes of stuff to do and she seemed quite harrassed.

After the ECG I tagged the MO again and followed her to the isolation wards 61 and 62 to clerk some new admissions. This was about 10.20 p.m. I saw the nurse who was on TV this week! Mwahaha again. Anyway the old lady we clerked first turned out to have dengue fever. It was amusing because we had to wear N95 masks to enter the patient's room and when I pulled open the drawer I realised I didn't know what my size was, so I just grabbed one randomly. It fit okay, and wasn't all that important anyway since it was just dengue, and the patient just happened to be there because of overflow.

I was quizzed by the MO about dengue after we finished the clerking, and was quit aghast to find that Microbiology has totally departed my brain, and I couldn't even remember the family of viruses the dengue virus is a member of, only managing a feeble "It's an RNA virus.. and that's all I can remember". Sigh. And I didn't know what the signs of plasma loss that signify DHF and DSS are either! Okay so I didn't really like studying dengue in M2, but I realise the importance of knowing these things now. She must think I'm totally insipid or something, meep.

Then it was 11.05 p.m. and the MO said, "You should go, or you'll miss the last train. There are new cases all the time." So I went off home. Wow, 6.5 hours of non-stop walking about the hospital and seeing more than I've ever seen so far. I didn't mention it just now, but I saw someone who had departed and someone who was in terminal dyspnoea, which was pretty sobering. At the end of it all I wasn't really tired, though my feet were aching, and I wasn't hungry even though I didn't have dinner. It was kind of like a wake up call, something slapping me and saying, Here, look at what it means to be a real doctor. And now I know that I have so much much more to do before I get there, and I have to work so much harder than I ever have if I want to be a good doctor. All this while I think I'm pretty comfortable where I am and spending a lot of time on other trivial pursuits, but I'm wrong.

Oh well. Everytime I tell anyone this they look at me like I've gone totally mad. It's not like I'm saying we have to give up all pleasures and go crazy studying, but it's just the realization that, you know, things really aren't as simple as we think they are, and we need to remember that at the end of all this we want to be good doctors. I shan't be preachy, though I suspect I've already been far too preachy for my own good.

In the meantime, I need to brush up on my procedural skills so I won't screw up during night duties.

Avaris / 7/03/2005 01:39:00 PM

0 consumed